for Vascular Surgery Fellowship Program · and emergency room vascular consultation requests, and...

Program Manual

for

Vascular Surgery Fellowship Program

2020-2021

Date created: January 7, 2016 Date updated: August 4, 2020

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Table of Contents

Program Manual ........................................................................................................... 1 Overview of the Fellowship Training Program ....................................................................... 4

Program Director, Associate Director, Coordinator & Staff ........................................................ 5 Facilities ....................................................................................................................................... 6 Core Faculty ................................................................................................................................. 9 Additional Faculty and Services................................................................................................... 9

Training Program Curriculum .............................................................................................. 11 Didactics ....................................................................................................................................14 Training Program Block Schedule ..............................................................................................20 Conferences ...............................................................................................................................21

Goals & Objectives- Overall................................................................................................. 22 Goals & Objectives – By Site, Rotation AND Clinical year .........................................................23

Policies ............................................................................................................................... 36 Advancement Policy ..................................................................................................................37 BLS/ACLS/PALS/NRP/ATLS training Policy .................................................................................38 Case Log Policy & Procedure .....................................................................................................39 Chief Resident or Fellow Policy .................................................................................................40 Concerns and Complaints Policy ...............................................................................................41 Corrective Action and Disciplinary Policy ..................................................................................42 Disaster Policy ...........................................................................................................................43 Fellow Clinical and Education Work Hours Policy .....................................................................44 Evaluation Policy .......................................................................................................................46 Fatigue Mitigation Policy ...........................................................................................................47 Impairment Policy .....................................................................................................................48 Moonlighting Policy ...................................................................................................................49 On-call Policy .............................................................................................................................50 Professionalism Policy ...............................................................................................................51 Recruitment and Selection Policy .............................................................................................54 Supervision and Scope of Practice Policy (including Escalation) ..............................................55 Time-off and Effect of Taking LOA Policy ..................................................................................62 Transitions of Care ....................................................................................................................63

Book & Conference Fund .................................................................................................... 67 Patient Safety/Quality Improvement Resources, Expectations & Curriculum ........................ 68 Education and Scholarly Activities for Trainees .................................................................... 69 Education and Scholarly Activities for Faculty ...................................................................... 70 Clinical Competency Committee Description (CCC) .............................................................. 71 Program Evaluation Committee Description (PEC) ............................................................... 72

Evaluation of the fellow by the faculty .....................................................................................74 Evaluation of the faculty by the fellow .....................................................................................85 Multiple Evaluators (peers, self, etc) ........................................................................................87 Semi-Annual Evaluation (by the Program Director) ..................................................................95 Evaluation of the program by the fellow ..................................................................................98 Evaluation of the program by the faculty .................................................................................99 Other Evaluations ....................................................................................................................102

Examinations, Licensure & Certificate................................................................................ 103

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Policy for Resident/Fellow and Faculty Member Well-Being .............................................. 104 Mandated Online modules for House Staff ........................................................................ 107 NYULMC Medical Library .................................................................................................. 108 On Call Rooms .................................................................................................................. 109 Committee Participation for House Staff ........................................................................... 111 Additional Information ..................................................................................................... 112 Useful Links & Resources .................................................................................................. 114

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Overview of the Fellowship Training Program

The NYU Langone Medical Center offers a 2 year fellowship training program covering all

aspects of vascular and endovascular surgery. Under the guidance of Program Director Caron Rockman,

M.D. and Division Chief Glenn Jacobowitz, M.D., this program offers fellows a rich and extensive

opportunity to participate in difficult and complicated vascular surgeries, observe leading-edge clinical

research, and present at local and national vascular surgery conferences. Fellows complete the

fellowship program prepared to achieve board certification. Former graduates of this program have

received numerous awards and gained leadership positions throughout North America and around the

world.

The vascular surgery fellowship is a 2 year clinical program whose goal is the mastery of all

aspects of Vascular and Endovascular Surgery. It is expected that at the conclusion of the 2 year

fellowship program, the vascular fellow will be able to perform all the functions of a vascular surgeon,

including the demonstration of competency in the areas of patient care, medical knowledge, practice-

based learning and improvement, interpersonal and communication skills, professionalism, and

systems-based practice.

Each year, 1 new fellows enter the program and 1 fellow graduates, so that in any given year,

there are a total of 2 fellows: 1 first year fellow and 1 second year fellow. Each fellow rotates through

each of 4 blocks (a block being a 3 month rotation) each year, for a total of 8 distinct blocks by the time

the program is completed. Each of the 2 fellows is in a different block at any given point in time.

Each rotation during the fellowship program is designed to train the fellow in different aspects

of the vascular surgery practice, and each rotation may emphasize different competencies. By the time

the fellow completes the 2 year program, the fellow is expected to have achieved the goals and

objectives described for each block, and demonstrate the competencies required by each block, which

when taken together, demonstrate that the overall goals and objectives of the program have been

met.

NYULMC’s Department of Surgery also sponsors a Vascular Surgery Integrated Residency

program, which consists of five years of vascular and general surgery training. The program sponsors

one trainee per R year for a total of five trainees. The fellows and the chief vascular residents work

closely together to provide oversight of the vascular services at NYU, Bellevue, and the VA. Because of

the way the department of surgery has planned out the block schedules for vascular rotations, the

surgery chief residents, the vascular chief resident, and vascular fellows do not overlap in their care of

patients.

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Program Director, Associate Director, Coordinator & Staff Program Director Vascular Surgery Caron Rockman, MD [email protected] 2122630429 Associate Program Director Vascular Surgery Mikel Sadek, MD [email protected] 2122630429 Program Coordinator for Vascular Felicia Brockett [email protected] 2122636378 Education Program Manager for Dept. of Surgery Vivian Stellakis, MA [email protected] 6465014197

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mailto:[email protected]




Facilities

NYU Tisch Hospital Center 550 First Avenue, New York, NY 10016

NYU Tisch Medical Center; The Tisch Hospital of New York University Langone Medical Center is an acute-care general hospital consisting of 726 beds. The hospital is a general and tertiary care referral center located in midtown Manhattan. There are approximately184 beds dedicated to the Surgical Services and 33 Operating Rooms, including a state of the art Hybrid Endovascular Operating Suite. The patient population at NYU Hospital Center is ethnically diverse given its location in New York City. During their rotations at Tisch Hospital, vascular trainees are exposed to an incredibly wide variety of vascular surgical patients and diagnoses, consistent with a large urban academic general and tertiary care center. This includes both routine and complex diagnoses, surgeries and endovascular procedures in the following areas: aortic, cerebrovascular, mesenteric / renal, lower extremity, and venous procedures. Active faculty (including 9 full time board certified vascular surgeons), perform all of their private cases at Tisch Hospital, and vascular trainees are intimately involved in the preoperative, operative, and postoperative care of these patients. Trainees see patients with the Faculty in the clinics at least once per week, evaluate outpatients and perform preoperative assessment, planning, and evaluation, evaluate inpatient and emergency room vascular consultation requests, and participate intimately and extensively in the operative and postoperative care of the inpatient service. In-hospital support includes excellent physician extenders including experienced vascular Nurse Practitioners and Physicians’ Assistants.

The Hospital and Outpatient Faculty Vascular Clinics have two busy certified Non-Invasive Vascular Laboratories; most of the Vascular Faculty have either RVT (registered vascular technologist), or other appropriate ultrasonography experience and certification. The trainees have dedicated rotations through the Vascular Laboratory Service, but are also able to participate actively in the performance and evaluation of the studies on a daily basis. Didactic and educational conferences specific to Vascular and Endovascular Surgery are held at least 4 days per week at Tisch Hospital. The Vascular Faculty Suites also include an active and dedicated outpatient Vein Center, whereby trainees gain important experience in the outpatient care, evaluation, and procedural management of patients with varicose veins and venous insufficiency. The Vein Center includes three full time procedure rooms, where a variety of standard outpatient procedures are performed, including endovenous ablation, phlebectomy, and cosmetic sclerotherapy. Finally, the Tisch Hospital rotation includes participation in our Outpatient Vascular Care Center, a dedicated outpatient procedure facility where routine and complex outpatient endovascular procedures are performed, including: arteriography, venography, intravascular ultrasound (IVUS), balloon angioplasty and stenting, and atherectomy procedures. Here, the vascular trainee gains invaluable experience in the performance of these outpatient procedures on appropriately selected patient populations.

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Bellevue Hospital Center 462 First Avenue, New York, NY 10016

Bellevue Hospital Center Bellevue Hospital is the flagship of the New York City public hospitals system, and is a Level I Trauma Center. The patient population is ethnically diverse with large populations of East and South Asians, Eastern European, Hispanic and African American patients. This diverse patient population allows for cultural sensitivity training of our fellows. There are 12 active operating rooms. Bellevue Hospital functions as the premier Vascular and Endovascular referral center for the public hospitals system in New York City, and patients with unusual vascular diagnoses, trauma, or other diagnoses unable to be appropriately managed at other hospitals are frequently transferred to Bellevue for their care. This specifically includes complex aortic diagnoses, including aneurysms and aortic dissections. Additionally, the Bellevue Hospital rotations afford an excellent opportunity for the trainees to gain valuable experience in managing vascular trauma patients with both penetrating and blunt injuries. During their rotations at Bellevue Hospital, vascular trainees are exposed to a wide variety of diverse vascular surgical patients and diagnoses, consistent with a large urban public hospital system. This includes both routine and complex diagnoses, surgeries and endovascular procedures in the following areas: aortic, cerebrovascular, mesenteric / renal, lower extremity, and venous procedures. Because a certain percentage of Bellevue Hospital patients are indigent, trainees are also exposed to unusual end-stage or neglected disease, in patients who unfortunately have not been able to obtain access to routine medical management for vascular disease.

Bellevue hospital has three active Board-Certified Vascular faculty, who perform the majority of the cases here, vascular trainees are intimately involved in the preoperative, operative, and postoperative care of these patients. Trainees see patients in the weekly Vascular Clinic and a weekly Vein Clinic, evaluate outpatients and perform preoperative assessment, planning, and evaluation, evaluate inpatient and emergency room vascular consultation requests, and participate intimately and extensively in the operative and postoperative care of the inpatient service. In the operating room, vascular trainees are afforded an experience of graduated independence, whereby senior trainees can independently perform appropriate vascular surgical and endovascular procedures under the direct supervision of Faculty Attending Staff. In-hospital support includes physician extenders including experienced vascular Nurse Practitioners and Physicians’ Assistants. The Hospital has a busy Non-Invasive Vascular Laboratories; most of the Vascular Faculty have either RVT (registered vascular technologist), or other appropriate ultrasonography experience and certification. The trainees are also able to participate actively in the performance and evaluation of the sonographic studies on a daily basis. Didactic and educational conferences specific to Vascular and Endovascular Surgery are held at least 4 days per week at neighboring Tisch Hospital.

Veterans Affair Hospital Manhattan

423 East 23rd, Street, New York, NY 10010

Manhattan VA Harbor HealthCare System The Manhattan VA Harbor HealthCare System is one of the integrated institutions of the NYU Vascular fellowship. It offers the fellows a wide and excellent spectrum of vascular surgery cases with complex pathology typical of the Veteran population. The Manhattan site is the regional referral site for many of the other surrounding VA facilities which cannot provide complex vascular and endovascular care. During their rotations at the Manhattan VA Harbor HealthCare System vascular trainees are exposed to a wide variety of diverse vascular surgical patients and diagnoses, consistent with a veteran populations with an

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often significant history of tobacco use. This includes both routine and complex diagnoses, surgeries and endovascular procedures in the following areas: aortic, cerebrovascular, mesenteric / renal, lower extremity, and venous procedures. Because a certain percentage of VA Hospital patients are socioeconomially disadvantaged, trainees are also exposed to unusual end-stage or neglected disease, in patients who unfortunately have not been able to obtain access to routine medical management for vascular disease. The Manhattan VA Harbor HealthCare System has five active Board-Certified Vascular faculty, who perform the majority of the cases here, vascular trainees are intimately involved in the preoperative, operative, and postoperative care of these patients. Trainees see patients in the weekly Vascular Clinic and a weekly Wound Care Clinic, evaluate outpatients and perform preoperative assessment, planning, and evaluation, evaluate inpatient and emergency room vascular consultation requests, and participate intimately and extensively in the operative and postoperative care of the inpatient service. In the operating room, vascular trainees are afforded an experience of graduated independence, whereby senior trainees can independently perform appropriate vascular surgical and endovascular procedures under the direct supervision of Faculty Attending Staff. In-hospital support includes physician extenders including experienced vascular Nurse Practitioners and Physicians’ Assistants. Didactic and educational conferences specific to Vascular and Endovascular Surgery are held at least 4 days per week at neighboring Tisch Hospital.

Advanced Vascular Care 425 East 58th Street, New York, NY 10022

The Advanced Vascular Care (AVC) site of New York University Langone Medical Center is an outpatient facility tailored towards the elective treatment of vascular pathologies using minimally invasive techniques. The site comprises two rooms with fluoroscopic capabilities, and has a full complement of ancillary staff and nursing with a focus on treating arterial and venous pathologies using endovascular techniques. The patient population at AVC represents a subset of the vascular and endovascular patients from NYU Hospital Center, who require endovascular treatments and who are candidates for undergoing these procedures on an outpatient basis.

During their rotations at AVC, vascular trainees are exposed to the full complement of outpatient elective endovascular treatments, including peripheral arterial, central venous, and arteriovenous access maintenance. The technologies encountered include but are not limited to angiography/venography, balloon angioplasty, stenting, atherectomy, intravascular ultrasound, percutaneous thrombectomy, vena cava filter insertion and retrieval. Active faculty (including 9 full time board certified vascular surgeons), perform a majority of their outpatient elective endovascular interventions at AVC, and vascular trainees are intimately involved in the preoperative, operative, and postoperative care of these patients. As is the paradigm with all NYU outpatients, trainees see patients with the Faculty in the clinics at least once per week, and perform preoperative assessment, planning, and evaluation. In addition, since AVC is integrated into the NYU rotation, didactic and educational conferences specific to Vascular and Endovascular Surgery are attended at least 4 days per week at Tisch Hospital.

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Core Faculty Robert Montgomery-Chairman Department of Surgery [email protected] Vascular Surgery Fellowship Program Faculty Glenn Jacobowitz Chief, Division of Vascular Surgery [email protected] Caron Rockman Program Director [email protected] Mikel Sadek Associate Program Director [email protected] Patrick Lamparello Vice Chairman [email protected] Michael Barfield Core Faculty [email protected] Todd Berland Core Faculty [email protected] Neal Cayne Core Faculty [email protected] Karan Garg Core Faculty [email protected] Joanelle Lugo Core Faculty Joanelle.lugo@nyu;angone.org Thomas Maldonado Chief of Vascular – VA [email protected]

Additional Faculty and Services

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mailto:Joanelle.lugo@nyu;angone.org



Key: VA- Manhattan Veterans Hospital BH- Bellevue Hospital

TH-Tisch Hospital KM-Kimmel Hospital

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Training Program Curriculum

At Tisch Hospital, where there is an active day surgery center as well as private practice in an

office setting, fellows gain experience: supervising the vascular surgery service, with patients

directly under their care; scrubbing in on the more difficult and complex vascular cases; directly

overseeing general surgical residents, medical students, and nurse practitioners; and, seeing

patients in the offices of the vascular surgery attending faculty members.

At Bellevue Hospital, a level-one trauma center in one of the largest cities in the world, the

vascular fellow encounters broad and in-depth experience in the area of vascular trauma.

While the vascular fellow deals with all aspects of vascular surgery, Bellevue provides a

particularly rich experience in thoracic aortic aneurysms and dissections.

At the VA Hospital, the vascular fellow acts as a junior consultant for the vascular surgical

service. Here, fellows manage the in-patient service, oversee all consults, do the pre-operative

planning for and performance of all vascular cases (endovascular and open aortic cases,

peripheral arterial cases and venous operations), train general surgical residents in all of these

area, manage and oversee the outpatient clinic, manage the endovascular inventory of the

operating room, and work on academic research projects.

During the Outpatient Services rotation, the fellow participates in all aspects of the outpatient

experience. This includes working in the non-invasive Vascular Laboratory, where the fellow

learns to perform and interpret the results of non-invasive testing modalities necessary to the

diagnosis and treatment of vascular disease. The fellow is expected to qualify to take the RVT

examination for vascular laboratory certification. Additionally, the fellow spends time in the

Vein Center, where he learns how to diagnose the full spectrum of venous disease and perform

all appropriate treatments and procedures.

Research and Conferences

The academic education of the vascular surgery fellow is enhanced by the pursuit of clinical

research projects. Accordingly, fellows are provided with significant time for independent

reading, research and conference preparation.

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Each week, the Department of Vascular Surgery holds a conference at which the vascular fellows make

a presentation about a particular case or patient. All aspects of the disease condition and treatment are

discussed. Fellows must also attend the Department of Surgery’s weekly Mortality and Morbidity

conference, monthly Grand Rounds, daily teaching rounds at the location of their particular rotation as

well as monthly Journal Club meetings.

Patient Safety and Quality Improvement Curriculum A required Patient Safety and Quality Improvement curriculum was designed for all trainees in the

Department of Surgery with a one hour conference every other month, led by an attending facilitator. The

conference includes a presentation and discussion of the literature pertaining to each safety issue listed

below. This is followed by a review of NYU-specific data and comparison to the national data. Attendees

conclude with a review of the hospital’s policy for each safety issue and a discussion of what can be done

at the resident level to improve patient safety and outcome.

This curriculum will meet the following goals:

• Competency in Practice Based Learning

• Competency in Systems Based Practice

• Better understand the current health care environment and the roles of the major players (i.e., governmental and non-governmental agencies, hospitals, professional societies and advocacy groups) that shape the practice of medicine

• Be familiar with quality and safety literature

• Learn how to create evidence-based practice guidelines to improve patient safety and outcomes for the hospital as well as our own personal practices

Curriculum includes:

• Overall review of the current health care environment including policy, reimbursement, safety

initiatives and measures

• DVT prophylaxis

• Postoperative UTI

• Postoperative wound infection/wound protective devices

• Ultrasound guided CVL placement

• Postoperative confusion/hospital delirium

In addition to the didactic patient safety curriculum, the Department has a QI meeting every Friday with senior trainees to discuss every complication from the week on each service at Tisch and at Bellevue. The department has also developed a Quality Improvement Committee, that will report to the hospital Quality Improvement Committee that includes department trainees. Trainees also participate in resident-run Mortality and Morbidity conferences and root cause analysis as part of their core curriculum.

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Professionalism (SPICE) Curriculum- runs throughout the year - The Department of Surgery has a robust curriculum on professionalism and interpersonal communications. Below is our resident curriculum for 2013-2014. We inaugurated this curriculum five years ago and have improved and refined these interactive seminars each year. To test these competencies, we instituted annual OSCE (Objective Structured Clinical Examinations) with specially trained actors for our surgical resident learners.

The six interactive, small group sessions are centered on the following topics:

• Medical Malpractice and the Surgeon • Admitting Mistakes: Ethical and Communication Issues –Error Reporting • Delivering Bad News: Your Chance to Become a Master Surgeon • Interdisciplinary Respect: Team Communication • Working Across Language and Cultures: The Case for Informed Consent • Self-Care and the Stress of Surgical Practice

Participation in the Patient Safety, Quality Improvement, and Professionalism curriculums is mandatory of all Department of Surgery trainees.

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Didactics Monday

NYU Kimmel o 7-8a – Vascular Surgery Teaching Rounds

All Vascular teams from NYU, BH, VA o 7-8a – General Surgery/Endo Onc Teaching Rounds

Ranson, Spencer, MIS, ACS, and Endo/onc services o 7-8a – Colorectal Surgery Core Didactic Lecture

Bellevue Hospital Center o 7-8a – General Surgery Teaching Rounds o 7:30-9a – Surgical Oncology Tumor Board o 7:30-9a- Breast Surgery Tumor Board o 7-8a – Vascular Surgery Teaching Rounds

All Vascular teams from NYU, BH, VA VA Hospital

o 7:30-9A – Surgical Oncology Tumor Board o 7-8a – Vascular Surgery Teaching Rounds

All Vascular teams from NYU, BH, VA Tuesday

NYU Kimmel o 7-8:30a – Vascular Surgery Core Didactic Conference

All Vascular teams from NYU, BH, VA o 7-8a – Colorectal Core Conference (M&M, Journal Club, Case Conference) o 7-8:30a – General Surgery Teaching Conference

Resident Presentation Conference, Hernia Conference, Pancreas Conference (Sept – June only)

Bellevue Hospital Center o 7-8:30a – Vascular Surgery Core Didactic Conference

All Vascular teams from NYU, BH, VA VA Hospital

o 7-8:30a – Vascular Surgery Core Didactic Conference All Vascular teams from NYU, BH, VA

Wednesday

NYU Kimmel o 7-7:45a – Core General Surgery SCORE Conference

All surgery residents o 7-8a – Summer Skills Lab Sessions by class (R1, R2, R3, R4, R5) (July-Aug only) o 7-8a – Grand Rounds (monthly)

All surgery residents Bellevue Hospital Center

o 7-7:45a – Core General Surgery SCORE Conference

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All surgery residents o 7-8a – Summer Skills Lab Sessions by class (R1, R2, R3, R4, R5) (July-Aug only) o 8-1pm – General Surgery Academic Day o 7-8a – Grand Rounds (monthly)

All surgery residents VA Hospital

o 7-7:45a – Core General Surgery SCORE Conference All surgery residents

o 7-8a – Summer Skills Lab Sessions by class (R1, R2, R3, R4, R5) (July-Aug only) o 7-8a – Grand Rounds (monthly)

All surgery residents Thursday

NYU Kimmel o 7-8a – M&M Conference

Bellevue Hospital Center o 7-8a – M&M Conference o 8-1pm – Surgical Oncology Academic Day o 8-1p – Trauma and SICU Academic Day

VA Hospital o 7-8a – M&M Conference o 8-1pm – General Surgery Academic Day

Friday

NYU Kimmel o 7-7:30a – Vascular Surgery Teaching Rounds

All Vascular teams from NYU, BH, VA o 7-8a – Summer Skills Lab Sessions by class (R1, R2, R3, R4, R5) (July-Aug only) o 7-8a – R5 Chief Resident Oral Board Prep (Feb-June only)

Bellevue Hospital Center o 7-7:30a – Vascular Surgery Teaching Rounds

All Vascular teams from NYU, BH, VA o 7-8a – R5 Chief Resident Oral Board Prep (Feb-June only) o 8-9a – Trauma Lecture Series

VA Hospital o 7-7:30a – Vascular Surgery Teaching Rounds

All Vascular teams from NYU, BH, VA o 7-8a – R5 Chief Resident Oral Board Prep (Feb-June only)

All Conference attendance is mandatory. The ACGME requirement for resident conference attendance

is 75%.

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Vascular Surgery Clinical Conference (list clinical conference topics for the most recent complete academic year)

Name of faculty member in charge: Glenn Jacobowitz, MD

Frequency of clinical conference : 3 Tuesdays per month

Presenter

Title of Presentation Site # Name

Faculty or

Resident

Fellow/

PGY

William S. Johnson

Fellow 7 Vascular Surgery – A Military History

Caron Rockman, MD

Faculty N/A Evaluation of Surgical Risk

Glenn Jacobowitz, MD

Faculty N/A Three-Dimensional Imaging in Vascular Surgery

Heepeel Chang, MD

Fellow 7 COVID-19 and Vascular Disease

Thomas Maldonado, MD

Faculty N/A Vertebral Artery Disease

Neal Cayne, MD

Faculty N/A Understanding Patient Safety in Surgical Care

Peter Patalano, MD

Resident 4 Case Conference-Topic TBD

Patrick Lamparello, MD

Faculty N/A Evaluation and Management of Carotid Artery Dissection

Mike Sadek, MD

Faculty N/A Surgical Treatment of the Infected Aortic Graft

Todd Berland, MD

Faculty N/A Evaluation and Management of Carotid Artery Aneurysms

William S. Johnson, MD

Fellow 7 Vascular Surgery – Lymphedema Surgery

Katherine Teter, MD

Fellow 6 VEINS

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Glenn Jacobowitz MD

Faculty N/A Systematic Carotid Stenosis: Stroke and Transient Ischemic Attack

Karan Garg, MD

Faculty N/A Ethical Issues in Surgery

Joanelle Lugo, MD

Faculty N/A Carotid Body Tumor

Heepeel Chang, MD

Fellow 7 Type B Dissection – Endovascular Treatment Options

Todd Berland, MD

Faculty N/A Cardiac Risk Stratification

Michael Barfield, MD

Faculty N/A EVAR

Heepeel Chang, MD

Fellow 7 Pre-Operative Evaluation of Vascular Disease


Faculty N/A Vertebral Basilar Disease

Michael Barfield, MD

Faculty N/A Great Vessel Disease

Neal Cayne, MD

Faculty N/A Nontechnical Skills in Surgery

Katherine Teter, MD

Fellow 6 TBD

Peter Patalano, MD

Resident 4 Giant Cell and Takayasu Arteritis


Faculty N/A Penetrating Aortic Ulcer and Intramural Hematoma

Caron Rockman, MD

Faculty N/A Lower Extremity Ulcer and Wound Care

Heepeel Chang, MD

Resident 7 Aortic Dissection

Caron Rockman, MD

Faculty N/A Endovascular Management of Descending Thoracic Aortic Aneurysms

Thomas Maldonado, MD

Faculty N/A Endovascular Procedures for Reno vascular Disease

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Katherine Teter, MD

Fellow 6 Carotid Endarterectomy

Peter Patalano, MD

Resident 4 Non-operative Management of Abdominal Aortic Aneurysms

Karan Garg, MD

Faculty N/A Repair of Infrarenal Abdominal Aortic Aneurysms

Neal Cayne, MD

Faculty N/A Challenging IVC Filter Retrieval

Todd Berland, MD

Faculty N/A Percutaneous Thrombectomy of Dialysis Grafts in the Office Setting

Joanelle Lugo, MD

Faculty N/A Management of Ruptured Abdominal Aortic Aneurysms

Caron Rockman, MD

Faculty N/A Selective External Carotid Endarterectomy

Patrick Lamparello, MD

Faculty N/A Fenestrated and Branched Endografts

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Vascular Surgery Clinical Research Conference (list clinical conference topics for the most recent complete academic year)

Who is in charge of the conference: Glenn Jacobowitz, MD and Caron Rockman MD

Frequency of clinical conference : Quarterly

Presenter

Title of Presentation Name

Faculty or

Resident Fellow/PGY

1st. Quarter

Caron Rockman, MD

Faculty

Review of current institutional research projects

2nd. Quarter


Faculty


3rd. Quarter

Caron Rockman, MD

Faculty


4th. Quarter


Faculty Review of current institutional research projects

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Training Program Block Schedule Division of Vascular Surgery Vascular Fellowship Rotation Block 2020-21

F1

Block 1 2 3 4

Site

Site 1 Site 3 Site 2 Site 1

Rotation Name

Vascular /Vacation Vascular Vascular Vascular/Vacation

% Outpatient 20 20 20 20

% Research

F2

Block 1 2 3 4

Site

Site 1 Site 3 Site 2 Site 1

Rotation Name

Vascular Vascular Vascular/Vacation Tisch Lab/Research

% Outpatient 20 20 20 20

% Research 20

Key Site 1 Tisch/Kimmel Site 2 Bellevue Site 3 Veterans Hospital F1 Junior Fellow F2 Senior Fellow

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Conferences Annual UCLA Symposium (Moore Course) www.cme.ucla.edu This is a 4-day course which provides an in-depth, comprehensive, and current review of vascular and endovascular surgery, and it is co-sponsored by the Society for Vascular Surgery. It covers four significant categories of topics including open surgery, endovascular procedures, medical management and diagnostic and non-invasive imaging. It is particularly useful for those taking the vascular board examination and therefore the all fellows are to attend this course. Veith Symposium www.veithsymposium.org The Veith Symposium is a 5-day annual vascular event that represents the most cutting edge, comprehensive, and possibly the most well-attended meeting in the field of vascular surgery. It is setup in a series of 5-minute rapid-fire presentations that run the full successively the full duration of each day. It is geared towards all practitioners involved with vascular surgeries, procedures or interventions. It is also run by Dr. Frank Veith, who is on faculty at the NYU School of Medicine and is contributed to heavily by the NYU Vascular Surgery Faculty. All vascular fellow are required to attend at least one day of the meeting, at during each year of their training. Society for Vascular Surgery, Eastern Vascular Society, Society for Clinical Vascular Surgery, etc. www.easternvascular.org There are numerous opportunities for the vascular residents to attend one of the many other vascular meetings. These additional opportunities will be granted on an individual basis with priority given based on seniority and to those individuals who have abstracts/papers that are accepted to the meeting.

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http://www.cme.ucla.edu/

http://www.veithsymposium.org/

http://www.easternvascular.org/

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Goals & Objectives- Overall

NYU Langone Medical Center Division of Vascular and Endovascular Surgery

Goals and Objectives The vascular surgery fellowship is a 2 year clinical program whose goal is the mastery of all aspects of Vascular and Endovascular Surgery. It is expected that at the conclusion of the 2 year fellowship program, the vascular fellow will be able to perform all the functions of a vascular surgeon, including the demonstration of competency in the areas of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Each year, 1 new fellows enter the program and 1 fellows graduate, so that in any given year, there are a total of 2 fellows: 1 first year fellow and 1 second year fellow. Each fellow rotates through each of 4 blocks (a block being a 3 month rotation) each year, for a total of 8 distinct blocks by the time the program is completed. Each of the 2 fellows is in a different block at any given point in time. Each rotation during the fellowship program is designed to train the fellow in different aspects of the vascular surgery practice, and each rotation may emphasize different competencies. By the time the fellow completes the 2 year program, the fellow is expected to have achieved the goals and objectives described for each block, and demonstrate the competencies required by each block, which when taken together, demonstrate that the overall goals and objectives of the program have been met. The vascular service at TH comprises the attending faculty, the vascular fellow, a 1st (PGY1), and 2nd (PGY2) year categorical general surgery resident, and a team of dedicated vascular advance practice nurses and physician assistants. At BHC, the vascular service comprises a dedicated BHC vascular attending physician, vascular fellow, PGY1, a PGY3, and a dedicated vascular physician assistant (PA). At the VA, the vascular service comprises a rotating attending vascular faculty member, a vascular fellow, a PGY1, and a PGY2.

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Goals & Objectives – By Site, Rotation AND Clinical year

Vascular Surgery Fellowship Training Program

Rotation Specific Goals & Objectives: Vascular Surgery

VASCULAR SURGERY AT TISCH HOSPITAL

NYU Tisch Hospital- Fellowship Year 1

The goal of the Tisch Hospital Vascular Surgery rotation is to develop the trainee in all aspects of vascular surgical patient care in a tertiary care setting. Trainees are directly involved in patient care in both the inpatient and outpatient setting. Trainees are exposed to a wide variety of vascular surgical patients and diagnoses, including both routine and complex diagnoses, surgeries, and endovascular procedures in the aortic, cerebrovascular, mesenteric / renal, lower extremity, and venous domains. Trainees see patients with the Faculty in the clinics at least once per week, evaluate outpatients and perform preoperative assessment, planning and evaluation. They fulfill inpatient and emergency room vascular consultation requests, and participate integrally and extensively in the operative and postoperative care of the inpatient service, in a venue comprising state of the art operating rooms and a hybrid endovascular suite. The rotation is enhanced by additional participation in the busy non-invasive vascular laboratories, as well as the dedicated outpatient Vein Center and Endovascular Center. Specific Objectives Fellowship Year 1 Patient Care

1. Synthesize patient data to arrive at an organized differential diagnosis including all treatment options

2. Lead the surgical team, and provide supervision in the evaluation and management of complex perioperative problems in the vascular patient

3. Independently provide longitudinal care for vascular patients 4. Understand the preparation required for advanced vascular surgical procedures, including

imaging, equipment, devices, intraoperative positioning and draping 5. Handle surgical instruments proficiently, and make independent intraoperative decisions 6. Independently perform basic, intermediate, and some complex advanced vascular

procedures 7. Proficiently handle catheters, guide-wires and endovascular devices 8. Independently perform basic and intermediate endovascular procedures\ 9. Use imaging findings in operative planning for advanced procedures, and independently

use and interpret multidimensional imaging

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Medical Knowledge

1. Describe the rationale for the selection of intermediate vascular surgical procedures. 2. Describe areas for potential complications and measures for procedural success with

intermediate vascular surgical procedures. 3. Anticipate patient-specific risk for complications following intermediate vascular surgical

procedures, and describe appropriate treatment algorithms should these occur 4. Describe the rationale for the selection of advanced vascular surgical procedures 5. Describe the impact of patient-specific anatomy on the operative plan with regard to

advanced vascular surgical procedures 6. Describe areas for potential complications and measures for procedural success with

advanced vascular surgical procedures. 7. Anticipate patient-specific risk for complications following advanced vascular surgical

procedures, and describe appropriate treatment algorithms should these occur

Practice Based Learning

1. Become a highly effective teacher with an interactive educational style, and constructive educational dialogue.

2. Participate in local, regional and / or national educational activities or conferences. 3. Demonstrate application of M&M or other QI conference conclusions to own patient care 4. Exhibit on-going self-evaluation and improvement, including tracking and analyzing

patient outcomes Professionalism

1. Positively influence others by modeling professionalism 2. Consistently demonstrate integrity in all aspects of care and professional relationships 3. Recognize and address personal health issues in self and other members of the health

care team. 4. Ensure that others under his or her supervision respond appropriately to responsibilities

in a timely fashion 5. Act as a role model for attendance, promptness, and attention to assigned tasks.

Interpersonal and Communication skills

1. Customize emotionally difficult information, including participation in end-of-life discussion

2. Negotiate and manage conflict among patients and families 3. Assume overall leadership of a health care team 4. Take responsibility to ensure that clear hand-offs are given at transitions of care

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Systems Based Practice

1. Consistently and independently employ ALARA principles to minimize radiation exposure, while optimizing image quality

2. Coordinate the activities of all health care professionals on the team to provide optimal patient care

3. Participate in work groups or performance improvement teams designed to reduce errors and improve patient outcomes.

NYU Tisch Hospital- Fellowship Year 2

Specific Objectives Fellowship Year 2 General: Expertly achieve and implement all goals and objectives related to the Fellowship Year 1 level, and improve and expand as detailed below. Patient Care

1. Independently utilize patient data to arrive at an organized differential diagnosis, including primary and secondary treatment options, in a sophisticated fashion, even for complex diagnoses and patients

2. Independently lead the surgical team in the total care of the vascular surgical patient 3. Independently ensure that all necessary imaging, instrumentation, equipment, devise,

and medications are available, even for very complex vascular surgical procedures. 4. Independently perform basic, intermediate and advanced vascular surgical procedures,

including the most complex procedures. 5. Begin to competently teach and supervise other learners in the performance of vascular

surgical procedures. 6. Independently and expertly handle catheters, guide wires and devices, and make

independent intraoperative decisions 7. Perform advanced endovascular procedures, including troubleshooting and the

management of complications 8. Expertly use imaging findings in operative planning for advanced procedures, and

interpret subtle findings. Medical Knowledge

1. Demonstrate advanced knowledge of the procedural rationale for the most complex and advanced vascular surgical procedures.

2. Describe the impact of unusual patient-specific anatomic findings on the operative plan involving advanced and complex vascular surgical or endovascular procedures.

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3. Anticipate patient-specific risk for intraoperative or perioperative complications, and develop appropriate treatment algorithms


1. Coordinate conferences and case discussions 2. Demonstrate use of a system or process for staying abreast of changes in the literature 3. Publish a peer-reviewed manuscript or book chapter. 4. Participate in root-cause analyses and apply best evidence to make recommendations for

change.

Professionalism

1. Mentor others to promote professional behavior, and assertively modeling professionalism

2. Proactively modify schedules to ensure that those caregivers under their supervision maintain personal wellness and do not compromise patient safety.

3. Mentor others to promote timely completion of administrative tasks.

Interpersonal and communication skills

1. Negotiate and manage potential conflict among patients and families, members of the surgical team, and other care providers

2. Act as a role model for patients, peers, and staff members 3. Independently assume leadership of the health care team, while seeking and valuing

input from the members of the team.


1. Perform root-cause analyses for recordable or reportable events. 2. Initiate or complete a performance improvement project. 3. Function as a team leader for work groups or other performance teams designed to

improve patient safety and outcomes.

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VASCULAR SURGERY AT BELLEVUE HOSPITAL

The goal of the Bellevue Hospital Vascular Surgery rotation is to develop the trainee in all aspects of vascular surgical patient care in a public hospital care setting. Trainees are directly involved in patient care in both the inpatient and outpatient setting. Trainees are exposed to a wide variety of vascular surgical patients and diagnoses, including both routine and complex diagnoses, surgeries, and endovascular procedures in the aortic, cerebrovascular, mesenteric / renal, lower extremity, and venous domains. Trainees see patients with the Faculty in the clinics at least once per week, evaluate outpatients and perform preoperative assessment, planning and evaluation. They fulfill inpatient and emergency room vascular consultation requests, and participate integrally and extensively in the operative and postoperative care of the inpatient service. The rotation is enhanced by the social, cultural, and economic diversity of the patient population, affording the trainee the opportunity to work in an environment which values cultural competency in patient care.

NYU Bellevue Hospital – Fellowship Year 1

Specific Objectives Fellowship Year 1 Patient Care







Medical Knowledge

1. Describe the rationale for the selection of intermediate vascular surgical procedures.

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2. Describe areas for potential complications and measures for procedural success with intermediate vascular surgical procedures.

3. Anticipate patient-specific risk for complications following intermediate vascular surgical procedures, and describe appropriate treatment algorithms should these occur

4. Describe the rationale for the selection of advanced vascular surgical procedures 5. Describe the impact of patient-specific anatomy on the operative plan with regard to















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NYU Bellevue Hospital – Fellowship Year 2 Specific Objectives Fellowship Year 2 General: Expertly achieve and implement all goals and objectives related to the Fellowship Year 1 level, and improve and expand as detailed below. Patient Care











3. Anticipate patient-specific risk for intraoperative or perioperative complications, and develop appropriate treatment algorithms .

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change. Professionalism











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VASCULAR SURGERY AT VA HOSPITAL

The goal of the VA Hospital Vascular Surgery rotation is to develop the trainee in all aspects of vascular surgical patient care in a federal hospital care environment. Trainees are directly involved in patient care in both the inpatient and outpatient setting. Trainees are exposed to a wide variety of vascular surgical patients and diagnoses, including both routine and complex diagnoses, surgeries, and endovascular procedures in the aortic, cerebrovascular, mesenteric / renal, lower extremity, and venous domains. Trainees see patients with the Faculty in the clinics at least once per week, evaluate outpatients and perform preoperative assessment, planning and evaluation. They fulfill inpatient and emergency room vascular consultation requests, and participate integrally and extensively in the operative and postoperative care of the inpatient service. The rotation is enhanced by the social, cultural, and economic diversity of the veteran patient population, affording the trainee the opportunity to work in an environment which values cultural competency in patient care, and satisfies the requirements of a federally run institution.

NYU VA Hospital – Fellowship Year 1 Specific Objectives Fellowship Year 1 Patient Care







Medical Knowledge

1. Describe the rationale for the selection of intermediate vascular surgical procedures.

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2. Describe areas for potential complications and measures for procedural success with intermediate vascular surgical procedures.

3. Anticipate patient-specific risk for complications following intermediate vascular surgical procedures, and describe appropriate treatment algorithms should these occur

4. Describe the rationale for the selection of advanced vascular surgical procedures 5. Describe the impact of patient-specific anatomy on the operative plan with regard to















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NYU VA Hospital – Fellowship Year 2

Specific Objectives Fellowship Year 2 General: Expertly achieve and implement all goals and objectives related to the Fellowship Year 1 level, and improve and expand as detailed below. Patient Care











3. Anticipate patient-specific risk for intraoperative or perioperative complications, and develop appropriate treatment algorithms

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. Practice Based Learning


change.

Professionalism











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Vascular Lab Rotation – Fellowship Year 2

The goal of the Vascular Laboratory rotation is to provide trainees with the practical and

didactic training required to develop the knowledge and expertise required to become proficient

in the performance and interpretation of non-invasive vascular laboratory diagnostic

examinations. Simultaneously, the experience provides them with the appropriate training to

allow them to become eligible to take the Registered Physicians’ Vascular Interpretation (RPVI)

Examination and become certified by the ARDMS (American Registry for Diagnostic Medical

Sonography) at the completion of the training; this is also a requirement to be eligible to sit for

the board examination in vascular surgery. Trainees work directly in our certified vascular

laboratories at Tisch Hospital in the inpatient and outpatient setting, performing examinations in

the following areas: cerebrovascular, venous, arterial, aortic, mesenteric, and other

miscellaneous. They interpret examinations as well. They are supervised by both Attending

Vascular Surgeons as well as Registered Vascular Technologists throughout the course of the

rotation.

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Policies All GME Policies can be found at www.ATNYULMC.org under the Ellucid Application. Links have been provided for each policy list hereafter as applicable.

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Advancement Policy Department of Surgery

Vascular Surgery Fellowship Criteria for Promotion from one Fellow Level to the Next

Advancement from Year 1 to Year 2 requires:

1. Completion of all scheduled rotations with evaluations of 3 or greater in all competencies. Advancement with lesser grades is at the discretion of the Program Director and the Clinical Competency Committee, typically based upon demonstrated improvement, and/or ongoing compliance with a remediation or probation plan.

2. Completion of the online Sleep and Fatigue Module. 3. Completion of the Institutional Review Board HIPAA and Human Subjects Research (CITI) online

modules. 4. Completion of the New Innovations Advancement Checklist 5. Conference attendance of at least 75% or demonstration of a satisfactory alternative didactic (eg.

online review of missed seminars). See Policy on Conference Attendance 6. Completion of an appropriate and designated number of surgical cases in the designated year, as

determined by ACGME requirements and the Program Director and Clinical Competency Committee. 7. Completion of the GME NI Advancement Checklist. 8. Achievement of at least Level 2 in the ACGME / ABS Vascular Surgery Milestones Project in at least 75%

of Milestone categories. 9. Unanimous support among the Program Director, Associate Program Director, and members of the

Clinical Competency Committee that the trainee is at an appropriate level to move into Year 2.

Graduation from the Program requires: 1. Successful completion of all schedule rotations with evaluations of 3 or greater in all competencies.

Graduation with lesser grades is at the discretion of the Program Director and the Clinical Competency Committee, typically based upon demonstrated improvement, and / or ongoing compliance with a remediation or probation plan.

2. Complete and accurate procedure log to substantiate future credentialing. 3. Achievement of appropriate designated numbers of surgical procedures, as required by the ACGME. 4. Completion or satisfactory progress demonstrated in a meaningful research effort. 5. Current and complete portfolio and CV on file. 6. Completion / fulfillment of all “de-credentialing” requirements with the several hospitals, and signoff

by the Office of Graduate Medical Education. This includes return of all keys, lab coats, pagers, etc. The Program requires that graduating trainees also leave contact information for future communications.

7. Completion of GME NI Termination Checklist. 8. The graduate should be making appropriate plans to achieve Board Certification in the area of Vascular

Surgery 9. Achievement of at least Level 4 in the ACGME / ABS Vascular Surgery Milestones Project in at least 90%

of Milestone categories. 10. Unanimous support among the Program Director, Associate Program Director, and members of the

Clinical Competency Committee that the trainee is at an appropriate level to graduate.

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BLS/ACLS/PALS/NRP/ATLS training Policy https://nyumc.ellucid.com/documents/view/2447

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Case Log Policy & Procedure

Vascular Surgery Fellowship Training Program Case Log Policy and Procedures

Vascular Surgery Fellows need to perform a minimum of 250 major vascular reconstructive procedures that reflect an adequate representation of endovascular diagnostic and therapeutic cases, Endovascular Aneurysm repair, Abdominal, cerebrovascular and peripheral vascular cases as well as a breadth and balance of experience in the surgical care of vascular diseases. Cases can be logged by going to this link: https://apps.acgme.org/connect/login Defined Categories-

• Endovascular Diagnostic = 100 • Endovascular Therapeutic = 80 • Endovascular Aneurysm Repair = 20 • Abdominal = 30 • Cerebrovascular = 25 • Peripheral = 45 • Complex = 10

Fellows need to document a significant role in the following aspects of patient management: determination or confirmation of the diagnosis; provision of preoperative care; selection and accomplishment of the appropriate operative procedure; direction of postoperative care; and accomplishment of sufficient follow-up to be acquainted with both the course of the disease and the outcome of its treatment. Participation in the operation only, without preoperative and postoperative care, is not appropriate. Fellows also need to demonstrate competency with special diagnostic techniques for the management of vascular disease. It is essential that residents understand the methods and techniques of angiography, CT scanning, MRI and MRA and other vascular imaging modalities. They should be competent in the assessment of the vascular portion of such images. Fellows do a rotation on outpatient vascular lab where they learn about the application, assessment, and limitations of noninvasive vascular diagnostic techniques. Fellows attend a RPVI Certification Course which they require 500 ultrasound cases with technique in the following prior to sitting for the certification exam:

• Carotid duplex ultrasound • Transcranial Doppler • Peripheral arterial physiologic testing • Peripheral arterial duplex ultrasound • Venous duplex ultrasound • Visceral vascular duplex ultrasound

Trainees are responsible for logging and tracking their cases daily. Trainees are also responsible for advising the Program Director of any problems and concern regarding logging and accessing cases.

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Chief Resident or Fellow Policy


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Concerns and Complaints Policy

The NYU School of Medicine General Surgery Program is committed to maintaining an environment that is supportive and conducive to learning. As such, open communication with our residents is of utmost importance. In the event that an individual would like to discuss or report a concern or complaint, there are numerous opportunities for residents to do so, either directly or anonymously.

Residents have a professionalism session dedicated to “Admitting Mistakes – Error reporting”. They go over how to report errors at all 3 hospital locations.

Residents can contact Dr. Caron Rockman, Program Director, Dr. Mikel Sadek, Associate Program Director and or Dr. Leon Pachter, Chairman, or Michael Ambrosino, M.D., the Senior Associate Dean for Graduate Medical Education and DIO to discuss any issues of concern.

The NYU Langone Health Policy can be found here: https://nyumc.ellucid.com/documents/view/2473

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Corrective Action and Disciplinary Policy https://nyumc.ellucid.com/documents/view/3937

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Disaster Policy

In the event of a natural disaster, trainees should contact the program director, Caron Rockman, MD or associate program director Mikel Sadek MD, directly via e-mail or by phone. If they are unavailable, the trainees should contact the program coordinator or program manager via e-mail or by phone. Their contact information is listed in the Overview section of this program manual. Please also be sure to update all personal contact information in NYULMC’s peoplesoft to ensure that you can receive any updates from the medical center. https://nyumc.ellucid.com/documents/view/2478

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Fellow Clinical and Education Work Hours Policy The Vascular Surgery Fellowship at New York University School of Medicine considers the Duty Hour

Policy as absolutely mandatory and takes into account both the newly revised ACGME requirements as

well as the New York State Department of Health Duty Hour policies. The most restrictive policy

between the two is used here. Duty hours include all clinical and academic activities of the Fellow

i.e., patient care (both inpatient and outpatient), administrative duties related to patient care,

transfer of patient care, time spent in-house on-call, and scheduled academic activities such as

conferences. Duty Hours do not include reading and preparation time spent away from the duty site.

It is the policy of the Vascular Surgery Fellowship at New York University School of Medicine that the fellows

must maintain compliance with the following duty hour rules. Furthermore, all fellows should use

alertness management strategies while engaging in patient care. Surgical fellows at NYU School of

Medicine have reviewed the warning signs of fatigue, alertness management strategies, and strategic

napping policies during the mandatory fatigue recognition and management online tutorial and similar

lecture given by the Program Director. Strategic napping, especially after 16 hours of continuous duty

and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested.

Mandatory Logging Period – Fellows must be adhering to the Mandatory Logging Periods of April 1-30 and October 1-31. Mandatory Time Free of Duty – Residents must be scheduled for a minimum of one day free of duty every week. At-home call cannot be assigned on these free days.

It is the policy of the Vascular Surgery Fellowship at New York University Medical Center that the fellows are in compliance of the following duty hour rules. RULE 1: Duty hours MUST be limited to 80 hours per week, average over a four-week period. This is inclusive of all in-house call activities.

• If the fellow comes into the hospital for consults/rounds, the hours count towards the 80 hours. This includes home call.

• Each weekend, one fellow is on call (each fellow has one call per month, for a total of 13 weekend calls each year).

• On the weekends, the fellow who is on call MUST round, take care of consult notes as needed and finish his on-site work from 7am-12pm. The evenings are covered by the general surgery night float team.

• The fellow who is in the Outpatient Service rotation (where there is no call schedule) is always designed as the “relief fellow.” The relief fellow is there to step in and relieve the fellow who is on call, where that call might otherwise demand a breach of these rules governing duty hours.

RULE 2: Fellows must be provided with one 24 hour day/week free from all educational and clinical responsibilities.

• Fellows MUST turn off their pagers for 1 full day/week.

• Fellows taking home call also must comply with this rule and get 1 day off each week.

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RULE 3: Fellows must have a 10 hour period between shifts

• The 10 hour period starts once the fellow leaves the hospital and is relieved of all patient care responsibility.

• On any of the vascular surgery services, if a fellow is on duty for any period of time that would impinge on that fellow’s achieving his 10 hours of duty-free rest, then the relief fellow will step in for the fellow in need of rest. The requirement of duty-free rest is an absolute one and the fellow may not return for 10 hours

RULE 4: Fellows CANNOT work more than 24 hours consecutively.

• Fellows cannot be on duty more than 24 hours of continuous duty.

• At any time, if a fellow is on duty for any 24 hour period (even if that includes home call) then the relief fellow will step in for the fellow in need of rest. The requirement of duty-free rest is an absolute one and the fellow may not return for 10 hours

At-Home Call

a. Time spent in the hospital by trainees on “at-home call” must count towards the 80-hour

maximum weekly hour limit. The frequency of at-home call is not subject to the every-

third-night limitation, but must satisfy the requirement for one-day-in-seven free of

duty, when averaged over four weeks.

b. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal

time for each trainee. Trainees are permitted to return to the hospital while on at-home call

to care for new or established patients. Each episode of this type of care, while it must be

included in the 80- hour weekly maximum, will not initiate a new “off- duty period”

Process for monitoring compliance with these duty hour rules Each fellow is required to document his weekly duty hours (including on-site and home call) by filing out duty hours in New Innovations for the full months of April and October. The Program Director reviews the data and if he sees any incidence of non-compliance with these rules, he will meet with the fellow in violation of the rules and make necessary adjustments to ensure compliance. Violations are also reported to the monthly Program Evaluation Committee. The committee discusses a plan of correction for the violations. Violations are also discussed at the Annual Program Review Retreat. Fellows are expected to report to the Program Director any circumstances in which they experience excess fatigue or undue fatigue, stress or other situations which may impair their performance. The Program Director will take such action as may be necessary to correct this issue. A summary of the ACGME rules and requirements is put together in a contract that each faculty member and trainee MUST sign attesting that they will abide by the requirements and facilitate trainee duty hour compliance. Failure of a faculty member to facilitate resident compliance will result in being placed on a non-teaching service and receiving NO trainee coverage. For further information, please refer to the NYU GME policy located on ATNYULMC.org in the Ellucid application and the Fatigue Back Up Plan in the Fatigue Policy

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Evaluation Policy Vascular Surgery program has evaluations for trainees, faculty and the program in New Innovations.

New Innovation system

The Vascular Surgery Fellowship Program utilizes an electronic evaluation system called New Innovations, which maintains confidential evaluations. This system operates by coordinating a schedule of evaluations that must be submitted by all of the participants in the program (including the residents, attending faculty, the Program Director, and other personnel at the medical center) and email reminders to each of these participants.

Each email reminder contains a link to the actual evaluation, so that a simple click enables the resident

and/or faculty to complete the evaluation electronically.

Fellows have access to completed evaluations on New Innovations 24/7.

The system compiles the evaluations into a report for the Program Director so that he is able to

monitor compliance with all of the rules and requirements of the Program. If, for example, the

evaluations point out a deficiency in a particular area, the Director is made aware and can take steps

to remediate the deficiency. Additionally, the system also sends the Director reports about the

instances of failure to complete the evaluations themselves, ensuring the ability to monitor

compliance with the Program requirements.

-Faculty member from each rotation evaluates residents on that service on a monthly basis

-Junior fellows complete an evaluation of their senior fellows on a monthly basis

-Senior fellows evaluate junior fellows on a monthly basis

-All trainees evaluate faculty after each rotation

-All trainees and faculty evaluate the program at the end of the year

The program evaluation committee holds an annual retreat to discuss all the program evaluations

along with rotation changes that need to be made for the new academic year. In addition to the

comprehensive annual retreat, there are also monthly meetings to discuss the same issues and other

issues which may arise throughout the academic year.

ACGME Survey The ACGME also conducts an annual survey of the fellows and faculty about the Program and sends the information to the Program Director. The Program Director reviews the survey and takes steps to address any deficiencies that the survey identifies. Deficiencies are addressed by the Program Evaluation Committee, the Program Director and Core Faculty, along with input from the appropriate designated trainees. For further information, please refer to the NYU GME policy located on ATNYULMC.org in the Ellucid application.

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Fatigue Mitigation Policy


Vascular Surgery Fatigue Back up Plan: The Division of Vascular Surgery has put in place the following back up plan for when a fellow calls in sick or is unable to show up as scheduled due to fatigue. Is it the responsibility of the faculty and peers to recognize when a colleague or trainee is fatigued. Self-recognition is also very important. The Department will provide coverage by reassigning a surgery or vascular resident from the following:

1. A resident who is doing an elective rotation 2. A resident from services such as breast, endocrine, endoscopy where the clinical demands are less on residents 3. A resident who is doing on site research and is credentialed as an assistant in service by NYU Langone Medical Center.

In addition, for the fellows, the attendings are available to step in with 24/7 in house attending at Bellevue, Tisch and the VA. Coverage in situations as above is coordinated by direct communication with the Program Director or Associate Program Director.

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Impairment Policy https://nyumc.ellucid.com/documents/view/3098

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Moonlighting Policy NYU Langone Health

NYU Department of Surgery

Vascular Surgery Fellowship

Policy on Moonlighting

The Vascular Surgery fellow will not be permitted to moonlight for the duration of the training

program.

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On-call Policy Vascular Surgery fellowship program follows General Surgery program which has night float services at Tisch and Bellevue hospitals for Sunday to Thursday. The Night Float service is an entirely separate rotation. The services are staffed as follows: Night Float Service at Tisch Hospital House Staff Complement: R4, R2 Night Float Service at Bellevue Hospital House Staff Complement: R5, R3 (the R1s work 12 hour shifts at all three institutions). The Night Float Services at both Tisch and Bellevue will be responsible for all patient-care issues, consults, and OR cases starting on Sundays 7AM through Monday 7AM. They also cover Monday-Thursday 6PM-7AM. The members of this service will absolutely leave no later than 7am (other than for Wednesday and Thursday conference). The primary goals of the Night Float Service are: 1) To provide full-service patient care during the night hours, and 2) To support the primary surgical services so that the primary-team residents can maximize the benefit of their time in the hospital during the weekdays. 3) All patient and educational conferences at NYU School of Medicine have been moved to morning so that both the night float and the daytime teams can attend all conferences. There is a R4 and R2 on call for Tisch and R5/R3 on call for Bellevue and VA Hospital from 7AM until 8AM on Saturdays. Calls at VA Hospital are from home. The R3 takes first call and R5 provides back up, with the fellow also available on call. Attending supervision is indirect off-site, available by phone. Senior Residents R4s and R5s are available on site, and Fellows are on at home call with the availability to be called in. The first-call and second-call (backup) fellows will be on call for Tisch/Bellevue and VA Hospital from 7PM until 8AM on weekdays, and from 7AM until 8AM on weekends and Tisch/Bellevue and VA Hospital holidays. All call is at-home call and fellows will be immediately available by pager and/or telephone. Fellows must be able to see patients in hospital within 20 minutes of being called. The first-call fellow will not hesitate to solicit the second-call fellow for help and consultation as needed. The second–call fellow will not hesitate to come in to the hospital, see patients or perform procedures in conjunction with the first-call fellow. The second-call fellow will also perform consultation or procedures as needed when the first-call fellow is already engaged, preventing his/her attending to the second consultation in a timely fashion. This holds true as well when the first-call fellow is unduly stressed or fatigued. Please not that fellows do not break duty hour regulations when on call. Each fellow has 1 day off in 7, and does not work more than 24+3 hours at a time (this includes at home call). For more information regarding the lines of supervision and escalation when on Night Float rotations, please refer to the Departmental specific Supervision and Escalation Policy located in this manual.

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Professionalism Policy The training program in Vascular Surgery adheres to the institutional policy on professionalism. As part of the curriculum designed to enhance Professionalism, the Program requires that the trainees participate in the following 6 lectures. We also have incorporated the Professionalism Evaluations under the Direct Observation Program in clinics which is under the direction of Donna Phillips and the evaluations are in NI.

a. Advanced Communication Skills for Surgical Practice b. Admitting Mistakes: Ethical and Communication Issues – Error reporting c. Delivering Bad News - Your Chance to Become a Master Surgeon d. Working With Professionals Around You: Team Communication e. Working Across Language and Cultures: The Case for Informed Consent f. Self-Care and the Stress of Surgical Practice g. UME: Residents as Teachers

Trainees are also evaluated on an annual basis by a Professionalism OSCE exercise conducted in the NY SIM Center.

NYU School of Medicine Issuing Department: Graduate Medical Education Effective Date: 04/08/2013 Reissue Date: 01/01/2016 Professionalism in Graduate Medical Education I. Summary of Policy The ACGME Common Program Requirements state the following with regard to professionalism in Graduate Medical Education:

Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: IV.A.5.e).(1) compassion, integrity, and respect for others; IV.A.5.e).(2) responsiveness to patient needs that supersedes selfinterest; IV.A.5.e).(3) respect for patient privacy and autonomy; IV.A.5.e).(4) accountability to patients, society and the profession; and, IV.A.5.e).(5) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

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II. Policy Purpose In addition to policies and expectations set by other organizations and institutions (such as the ACGME, AOA, AAMC, Joint Commission, and hospital policies), this policy sets the professionalism expectations of House Staff Officers and faculty in Graduate Medical Education at NYULMC. III. Applicability of the Policy This policy applies to all House Staff Officers at NYULMC. Additionally, when applicable, this policy sets expectations for program directors and faculty. IV. Definitions (if applicable)

A. House Staff Officer - a physician who is enrolled in an accredited or non-accredited NYUSoM or NYUHC Training Program for a clinical specialty or subspecialty this includes all Residents and Clinical Fellows.

B. Sponsoring Institutions- NYU School of Medicine and NYU Hospitals Center V. Policy

A. Professionalism

a. Responsibilities: All House Staff Officers are expected to: i. Adhere to The NYULMC Code of Conduct and all policies of Office of GME, NYULMC,

HHC, VA, and any other policies that apply to House Staff Officers or the institution/location at which they are working.

b. In the Curriculum

i. In the Common Program Requirements, the ACGME states that evaluation and teaching of professionalism “is most effective when done in the context of patient care and related activities, (e.g., conducting QI projects, leading a team, presenting M&M, reflections on practice, conversation with mentor.” Program Directors and faculty must ensure the integration of professionalism into all possible aspects of the curriculum.

ii. Programs must incorporate education about the appropriate scenarios in which a House Staff Officer should ask for help. Each program must determine appropriate escalation procedures. These escalation procedures must be provided to House Staff Officers.

iii. Programs must incorporate education about error reporting procedures for all locations at which House Staff Officers will work.

iv. House Staff Officers must be appropriately educated about retaliation, how to recognize retaliatory actions, and the appropriate methods for dealing with such.

c. Evaluations and Feedback: Evaluations must be completed, as stipulated in the ACGME

requirements and the NYU Evaluation Policy for Graduate Medical Education. In addition:

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i. Both the evaluator and the individual being evaluated are expected to respect diversity of opinion.

ii. House Staff Officers must be open to accepting evaluations and feedback on their performance in all areas of training, and incorporate evaluations and feedback into their practice.

d. Error Reporting, Concerns, and Complaints: House Staff Officer are at the front line of

patient care, and are expected to report any errors or incidents using the appropriate methods. This practice is essential to patient care and quality improvement, and should be encouraged. In addition:

i. House Staff Officers are expected to submit any concerns or complaints as defined by the “House Staff Officer Concerns or Complaints” Policy. The appropriate mechanisms for submitting such information at each institution are available in this policy.

ii. If a situation or concern does not need to go through the formal processes listed above, House Staff Officers should approach their supervisor, the next highest ranking individual if the issue involved the supervisor, the Office of GME, and/or the Associate Dean of Graduate Medical Education.

iii. Programs are responsible for educating House Staff Officers about the error reporting methods at each hospital. Please refer to the “In the Curriculum” section of this policy.

iv. Programs must ensure that error reporting mechanisms are available to House Staff Officers at all times.

e. Quality Improvement and Patient Safety: House Staff Officers are expected to:

i. Participate in quality improvement and patient safety projects during their time of training.

ii. House Staff Officers are expected to be aware of quality improvement initiatives that are taking place at the hospitals in which they work. When possible and appropriate, House Staff Officers should actively participate in these initiatives.

iii. Programs are responsible for providing the appropriate education to House Staff Officers about institutional/hospital quality improvement initiatives.

B. Retaliation a. In order to provide all House Staff Officers with a culture of safety, and to ensure that they

feel comfortable reporting errors and providing feedback, asking for help, and reporting lapses in professionalism by colleagues, any and all retaliatory actions taken against a House Staff Officer should be escalated to his/her supervisor, or the next highest ranking individual in the event that the House Staff Officer’s supervisor is involved. Such incidents can also be reported directly to the Office of GME, and the Associate Dean of Graduate Medical Education.

C. Unprofessional Behavior and Remediation

a. Any lapses in professionalism will be handled according to the “Corrective Action and Disciplinary Policy for House Staff Officers.”

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Recruitment and Selection Policy

Applicants for the Vascular Surgery Fellowship must have completed a five-year Surgery Residency by the time they would enter the Vascular Surgery Fellowship Program.

The Vascular Surgery Fellowship Program at NYULMC participates in the Electronic Residency Application Service (ERAS) and the National Residency Matching Program (NRMP) for the recruitment and selection of Housestaff. Applications submitted through ERAS must include a medical school transcript, 3 letters of recommendation including a letter from the Surgery Chairman, and ABSITE scores. Applicants are notified via email of all the documentation that is required for a complete application. Once an application is complete the Department Selection Committee reviews applications looking at the following criteria:

• Medical School Transcript

• USMLE Scores step I and preferably Step II as well

• Letters of Recommendations

• Chairman’s letter

• Personal Statement

• ABSITE Scores

• ECFMG certificate if applicable

Selected applicants will be invited to interview. Invitations to interview are sent via email and applicants are offered an interview date which is filled on a first come, first served basis. All applicants that are not selected to interview are notified via email. Interviews are conducted from January through mid-March. The offer of a fellowship position is not final until all information about matters that are relevant to credentialing has been finalized.

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Supervision and Scope of Practice Policy (including Escalation)

DIVISION OF VASCULAR OF SURGERY

This Policy for Supervision for Vascular Surgery Fellowship is intended to supplement the official institutional policy approved by the Graduate Medical Education Committee and is titled “New York University School of Medicine Supervision of Residents, Subspecialty Residents, and Fellows policy.” The full institutional policy is available at ATNYULMC.org under the Ellucid application.

Fellow supervision is the key to a successful fellowship training program. For a Vascular Surgery Fellowship, this supervision must take place not only on the wards and in the outpatient/clinic setting, but in the operating room as well. Optimal supervision of the fellows benefits all participants in the patient-fellow-faculty relationship. When fellows are optimally supervised, outstanding patient care is guaranteed. Furthermore, progressive fellow responsibility can only be accomplished and allowed when there is continuous supervision, assessment and feedback. Finally, since the attending staff is ultimately accountable for the care delivered to patients and the supervision of the fellows, a formal supervision policy guarantees that the surgical faculty is committed to both outstanding patient care and outstanding residency training.

The goal of the Fellowship Training Program in Vascular Surgery at New York University School of

Medicine is to provide an academic environment to train the surgeons of tomorrow. An important tenet of our training is insuring they are properly guided and supervised. Only in this way can our faculty guarantee patient safety and appropriate standard of care, promote fellow development in the Accreditation Council for Graduate Medical Education (ACGME) Core Competencies, and reinforce its commitment to training and supervision of the surgical fellow. It is equally critical for our faculty to train our fellows to become effective supervisors themselves. We expect all fellows to closely supervise medical students and senior fellows to oversee junior fellows.

The ACGME requirements state that, “Fellows must be supervised by teaching staff in such a way that the fellows assume progressively increasing responsibility according to their level of education, ability, and experience.” Furthermore, on-call schedules for teaching staff must be structured to ensure that supervision is readily available for fellows on duty and the teaching staff must determine the level of responsibility accorded to each fellow.

The Department of Surgery at NYU believes that fellow supervision has many components and many objectives as outlined below.

1. The Faculty

• Attending surgeons who comprise the teaching faculty for the fellows are chosen by the Chairman and Program Director based on their simultaneous commitment to fellows (education, personal and professional maturation) and patients (optimize safety and level of care). Faculty supervision assignments should be of sufficient duration to assess the knowledge and skills of each fellow. Faculty will delegate portions of patient care to fellows based on the needs of the patient and the fellows’ skills. Characteristics that make for appropriate fellow supervisors include:

a. Availability b. Approachability

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c. Open to diverse opinions d. Dedication to truth and integrity e. Compassion f. Promote team approach to fellow education and patient care

2. Tools and Assessments Used for Supervision

a. Direct oversight by faculty on the wards, outpatient setting, and b. operating room. c. Skills laboratory- direct faculty oversight and assessment of d. competence in the simulation setting. e. Competency curriculum- Objective structured clinical examination (OSCE). The OSCE’s, used

to evaluate progress through the Competency Curriculum, are evaluated by faculty and report cards reviewed with fellows.

f. VSITE (American Board of Vascular Surgery In Training Examination) yearly examination to assess medical knowledge. The VSITE Examination is a combination of both vascular and general surgery medical knowledge questions. Because of the extensiveness of the examine, examinees are allowed seven hours to complete the examination.

g. New Innovations- web-based evaluations of each fellow by faculty, other fellows, other healthcare team members, and the fellows themselves. The teaching faculty is also evaluated by fellows in an anonymous fashion.

h. Scope of Practice- a list of all procedures (invasive and non-invasive) that specifies level of supervision necessary per fellow year. The CCC determines the Scope of Practice every six months based on the observation and clinical advancement of the fellow.

i. Procedural competency log in New Innovations include non-operative invasive procedures which are supervised and assessed by faculty members on the clinical competency committee who determine level of competency. This will allow for an individualized, fellow-specific scope of practice.

Specific Policies for Supervision Levels of Supervision PGY 1 fellows should be supervised directly or indirectly with direct supervision immediately available. Fellows must communicate with supervising faculty on the service regarding the transfer of patients to the Intensive Care Unit and end of life issues. To ensure oversight of fellow supervision and graded authority and responsibility, the program must use the following classification of supervision; 1. Direct supervision- the supervising physician is physically present with the fellow and patient 2. Indirect Supervision: a. With direct supervision immediately available – the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision. b. With direct supervision available – the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision. 3. Oversight – The supervising physician is available to provide review of procedures/ encounters with feedback provided after care is delivered.

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Supervision for Inpatient Care In the clinical learning environment, each patient must have an identifiable, appropriately credentialed and privileged attending physician who is ultimately responsible for that patient’s care. This information should be available to fellows, faculty members, and patients. Fellows and faculty members should inform patients of their respective roles in each patients care. 1. Supervising faculty members are available for immediate supervision in person or by telephone.

a. Bellevue Hospital: There is in-hospital 24 hours/7 days per week surgical faculty supervision and coverage.

b. Tisch Hospital and Manhattan VA Hospital: Specific schedules are prepared in advance and distributed to all fellows and throughout the hospital. These schedules note which faculty member is responsible for fellow supervision and patient coverage at all times.

2. To allow for supervised progressive responsibility, fellows will make patient rounds on their service/hospital each morning. When appropriate, they will also round on patients in the afternoon or more frequently as needed. Patient care plans are formulated by the fellows and then presented to the supervising faculty member. As outlined in the goals and objectives, the fellows actively assume increasing patient care responsibility, while being closely supervised by the faculty. 3. Intensive care units at Bellevue and Tisch are supervised by surgical and/or critical care faculty 24 hours/7 days per week. This is in addition to the faculty member primarily responsible for the patient’s care. At the VA Hospital the Anesthesia Critical Care faculty covers in-house. This is in addition to the on-call supervising surgical faculty member covering the VA Hospital. Supervision of Outpatient Experience 1. At each site, the outpatient experience is directly supervised by the surgical teaching faculty.

a. Bellevue and VA clinics: Each clinic is staffed by at least one full-time faculty member who is present for the duration of the entire clinic, providing full-time supervision. b. At NYU Hospital: The fellow will attend an individual teaching attending’s clinic/office hours and direct supervision will be provided by that member of the faculty.

2. In the outpatient setting, the fellow performs a history and physical examination and presents to the faculty member. Together, all imaging studies and pathology reports are reviewed. With progressive responsibility, the fellow will then present his/her plan of action to the supervising attending. When the plan is finalized, the fellow and supervising faculty member will go together to the patient’s room to further discuss with patient and clarify any issues. Supervision in the Operating Room 1. All operative procedures are performed under the direct supervision of an attending surgeon. The attending surgeon must document his/her supervision throughout the case.

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2. Standard operating procedure at Tisch, Bellevue, and the VA Hospital dictates that the responsible surgical attending be present in the specific operating room and personally perform the “time out” prior to deliverance of anesthesia. 3. For procedures performed in the intensive care unit or in the trauma unit of the Emergency Department, direct fellow supervision is required. Critical care attending staffing is noted above with in-house coverage at Tisch and Bellevue and coverage until midnight at the VA Hospital. Supervision of Duty Hours 1. All teaching faculty and all fellows have received in-service regarding duty hour regulations.

a. Faculty must supervise fellow duty hours and every teaching attending has signed a Departmental attestation that he/she not only understands the duty hour rules, but will facilitate fellow compliance with all duty hour regulations. b. All fellows must monitor their own duty hours and senior fellows must monitor duty hours of their junior fellows working under them. Each fellow has signed a Departmental attestation that he/she understands all of the duty hour rules and will abide by them and facilitate other fellows complying with the hours regulations.

2. The Program Director supervises duty hour compliance through monitoring the reporting system in New Innovations. Supervision to Guard Against Fatigue and Sleep Deprivation 1. All fellows and all teaching faculty members have received fatigue and sleep deprivation tutorials. These educational tutorials have been designed to raise awareness of the dangers of sleep deprivation and fatigue and to educate as to how to recognize the signs and symptoms of fatigue and sleep deprivation. 2. It is the responsibility of all supervising faculty members, the Program Director, and the Site Supervisors to be vigilant and to identify any fellow who may be impaired by fatigue or sleep deprivation. 3. Responsibilities of the supervising faculty member include:

a. Responsible, professional behavior dictates that when a fellow recognizes that he or she is suffering from fatigue or exhaustion, he or she must notify their supervising attending or the program director immediately. b. The supervising attending or Program Director will immediately relieve the fellow of clinical responsibility and send him/her home to allow time for sleep. c. The fellow will be considered ONLY in a positive light for putting the safety of their patient first. Under no circumstances will this be considered a negative occurrence by faculty or other fellows. d. The chief fellow must not only be aware of the possibility of their own fatigue, but will also monitor the junior fellows for signs of fatigue. The chief fellow will immediately relieve the fatigued fellow of all clinical responsibility and they will contact the supervising faculty member and/or program director.

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e. It is also the responsibility of supervising faculty member to recognize the signs and symptoms of fatigue amongst the fellows, relieve the affected fellow immediately, and arrange for alternative coverage for that physician.

Graduated Levels of Responsibility The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each fellow must be assigned by the program director and faculty members. This progression of scope of practice is determined by the Clinical Competency Committee or CCC. 1. The program director must evaluate each fellow’s abilities based on specific criteria. When available, evaluation should be guided by specific national standards-based criteria. This occurs on an informal basis monthly, following each rotation, with the Program Director assessing New Innovations evaluations provided by the Vascular Surgery Core Faculty. On a more formal semi-annual basis, the CCC performs specific milestones evaluations of all trainees. 2. Faculty members functioning as supervising physicians should delegate portions of care to fellows, based on the needs of the patient and the skills of the fellows. 3. Senior fellows or fellows should serve in a supervisory role of junior fellows in recognition of their progress toward independence. This occurs on a continuous basis, based upon the Department of Surgery guidelines for the Fellow Expectations of Surgical Education of Medical Students and Junior Fellows. Emergency Situations An "emergency" is defined as a situation where immediate care is necessary to preserve the life of, or to prevent serious impairment to the health of a patient. In such situations, any fellow, assisted by other clinical personnel as available, shall be permitted to do everything possible to save the life of a patient or to save a patient from serious harm. The appropriate attending physician will be contacted and notified of the situation as soon as possible. The fellow will document the nature of that discussion in the patient's record. SUMMARY Residents, subspecialty residents and fellows treat patients at all of the affiliated hospitals under the supervision of staff attending physicians who are independently licensed and duly credentialed by each institution. All inpatients and outpatients will be assigned an attending physician of record who is responsible for his/her care and for determining and implementing the appropriate level of supervision of the trainee along with the Program Director. Patients shall be notified of the name of the attending staff physician responsible for their care and that residents and fellows participating in their care are supervised by such staff physician(s). In providing clinical supervision to residents and fellows, supervisors should provide advice and support and should encourage trainees to freely seek their input. Residents and fellows are expected to make liberal use of the supervisory resources available to them and are encouraged to seek advice and input from their supervisors. The supervising physician’s involvement in a patient’s case shall be documented in the medical record.

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POLICY FOR ESCALATION

Fellows in the Division of Vascular Surgery at New York University School of Medicine are guided by rotation-based goals and objectives that include levels of supervision. They also are given a “Scope of Practice” both by postgraduate year and, for most procedures, based on their individualized skills and competency levels. These guidelines, however, do not always provide for the fellow a rationale approach to when they should escalate information to supervising faculty. Fellows must not hesitate to contact a supervising faculty. The following serves as an escalation policy for fellows:

NOTIFY a more senior team member (Attending and Chief Resident) IMMEDIATELY “within 10 minutes” for

● Death – unexpected ● Cardio-pulmonary arrest or Surgical Airway ● MRT (Medical Response Team) call – Please note that any criterion to call for an

MRT needs to be communicated immediately (even if an MRT was not called) ● Level of care upgrade to a Post Op Unit or an ICU, no matter what the reason ● Deterioration in clinical status to include any of, but not restricted to, the following:

--acute neurologic event (e.g. seizure; TIA; CVA), no matter what cause --hemodynamic instability, no matter what cause --pulmonary distress or oxygen desaturation, no matter what cause --cardiac arrhythmia, sustained, recurrent, or not rapidly controlled --tachycardia when recovering from bariatric surgery --high fever, unexpected or not quickly suppressed --oliguria, unexpected, not responsive to simple therapy --pain, worsening or out of proportion to physical exam (e.g. ischemic) --pain, chest/back/abdominal with known/suspected aortic aneurysm --pain, abdominal with known/suspected mesenteric ischemia --neurologic symptoms with known/suspected arterial ischemia --change in pulse/Doppler or neurovascular exam of an extremity --medication error with untoward side-effect --fall with obvious injury

NOTIFY a more senior team member IN AN URGENT MANNER “within 1 hour” for

● Death – even if expected or with DNR status receiving comfort care ● Deterioration in clinical status to include any of, but not restricted to, the following:

--cardiac arrhythmia, even if self-limited or not needing specific treatment --high fever, even if expected or quickly suppressed --oliguria, even if expected or responsive to simple therapy --pain, unexpectedly persistent --unexpected vomiting even without aspiration --pneumothorax, even without requiring thoracentesis or tube thoracostomy --wound appearance change, worrisome for bleeding, infection, or disruption --medication error, even without untoward side-effect --fall, even without overt injury

● Significant change in vital lab value – even before a repeat, confirmation value is available. Depending on the clinical situation, immediate action may be needed.

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● Radiographic imaging results – whether crucial findings are “positive” or “negative.” The need to notify is considered mandatory. Moreover, the information relayed must be confirmed to have been received. This Departmental policy recommends alerting all--not just one—member of the team. The surgical attending must be notified of any of the above clinical events as soon as possible. What if the attending does not answer or answer appropriately?

On Vascular, Call Senior Vascular Fellow or Dr. Rockman (Vascular Surgery) Call Dr. Jacobowitz if Dr. Rockman cannot be reached

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Time-off and Effect of Taking LOA Policy

DEPARTMENT OF SURGERY DIVISION OF VASCULAR AND ENDOVASCULAR SURGERY

POLICIES AND PROCEDURES FOR RESIDENT TIME OFF AND LEAVE OF ABSENCE

The American Board of Surgery requires that each fellow must complete 48 weeks of full-time clinical activity in each training year (96 weeks total). The fellow will be required to make up excess time missed before he or she will be eligible for promotion within or completion of the program and before the specialty board will allow the fellow to take the board examination.

For documented medical conditions, including pregnancy and delivery, that directly affect the individual (i.e., not family leave), an additional 2 weeks off during the two years of training, for a total of 94 weeks required. No approval is needed for this option if taken as outlined.

Fellows are allotted a total of four weeks of vacation time every academic year (see GME policy below for more specific information).The fellows must request time away from his or her training program at the earliest date possible to allow time for the Program Director to arrange coverage in the Resident's absence. The fellows must submit corroborating documentation as requested to receive approval for time off (whether paid or unpaid) and, where applicable, to receive authorization to return to his or her training program.

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Transitions of Care Program Responsibilities in regard to Transitions of Care are as follows:

• The Program recognizes that its trainees will be required to demonstrate competence in the handover process and that the Faculty of the Program will teach and document that competence and implement a learning plan for the trainee who violates this Policy.

• The Program herein delineates its standard for transitions of care within the Department, Division and Program.

• The Program will implement the proper level of supervision for transitions of care as stated in its Policy of Supervision.

• All call schedules and rotation block schedules including attending schedules and contacts are made available to physician and non-physician providers via email. These schedules assure compliance with all applicable Duty Hour regulations and minimize the number of transitions of care in order to maintain continuity and safety of care.

Morning rounds start at 6am at Tisch hospital and 7am at Bellevue hospital where the entire fellow/resident team from the Night and new team for the Day along with the service PA/NP is present to discuss each patient on their service and transition of care takes place within 30 minutes so the night team leaves within the scheduled hours meeting duty hour regulations. In the evening, patient care transfer takes place over the course of a half an hour (beginning at 6 pm at Tisch and 7 pm at Bellevue). Junior residents sign out the service to the overnight junior resident and the senior resident signs out to the covering senior resident. Advanced care practitioners participate in the sign-out process as well. We have attempted to minimize interruptions during this period by making nurses aware that this is protected time, and all pages are deferred, unless in an emergency. The transfer of accurate information is facilitated by a Department of Surgery Sign-out Sheet. This is a list of pertinent patient information that is generated automatically by a combination of the electronic medical record and daily fellow/resident updates. The fellow, resident, ACP and attending call schedules along with their contact information is distributed well in advance of each rotation so that everyone is aware who is the responsible team for patient care each day and night. Transitions are supervised by Chief Residents. When the EPIC sign out form goes live in the Spring 2016, Faculty will begin formally evaluating transitions in real time to document competence on a consistent basis. Currently transitions are supervised and evaluated by Faculty informally. To the best of its ability, the Program is attempting to standardize Handoffs as follows:

• Patient Intro Name Age, Sex Surgical Problem(s)

• Periop/Hospital Course Intra-or Periop Events

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Unique anatomy Prolonged hospital course

• Current Devices Central Lines Tubes (NG, Foley) Drains

• 24 hr. Events Abnormal vitals Relevant I/O & Fluid management Diet changes Device changes Other interventions

• Safety VTE Prophylaxis Anticoag/Cardiac Meds Fall Risk

• System-Based Plan Current status, task by system Identify key consultants Neuro/Plan CV Pulm GI FEN Heme-ID Endo GU PPX Dispo

• Read-Back Questions and Clarification Read-back “action items and safety”

NYU School of Medicine Issuing Department:

Graduate Medical Education Effective Date: 04/01/2013

Reissue Date: 10/31/2014 Transitions of Care and Handoff Policy for House Staff Officers

I. Summary of Policy The ACGME Common Program Requirements state:

• Programs must design clinical assignments to minimize the number of transitions of patient care.

• Sponsoring Institutions and programs must ensure and monitor effective, structured hand-over

processes to facilitate both continuity of care and patient safety.

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• Programs must ensure that residents are competently in communicating with team members in

the hand-over process.

• The sponsoring institution must ensure the availability of schedules that inform all members of the health care team of attending physicians and residents currently responsible for each patient’s care.

II. Policy Purpose

The purpose of this policy is to ensure that all House Staff Officers and Program Directors are aware of the importance of safe and effective transitions of care. This policy aims to meet the requirements of the ACGME Institutional and Common Program Requirements with respect to transitions of care. III. Applicability of the Policy

This policy applies to all House Staff Officers in ACGME accredited training programs at NYULMC.

IV. Policy

Transitions of Care/Handoff Standards – The policies that are developed by each individual program must be sure that transitions of care occur in a standardized fashion, and include, at minimum, the following information/components:

a. Patient identifiers: Name, medical record number, date of birth

b. Admission information: Admitting physician, date and time of admission

c. Patient Summary: exam findings, lab results, any clinical changes since admission, including

changes in level of patient care and severity of issue(s)

d. Active issues: Current diagnosis, status, condition of patient, recent events.

e. Contingency plans (“If…/…then”) f. Family contacts

g. Discharge plans/instructions: Any discharge information given to patient,

anticipated discharge information. This should include discharge instructions to other

facilities or levels or care.

h. Anticipated action/changes: Expected tests or procedures.

i. Any changes in responsible attending physician and/or nurse

j. “Check for Understanding”: All transitions of care must be fortified with a

“check-back” to ensure that the receiver of information correctly understands all

information that has been provided.

B. Office of GME Responsibilities

a. The Sponsoring Institution must monitor programs to ensure that each program has a handoff/transitions of care policy that applies specifically to their specialty. These policies must be submitted to the Office of GME at least annually and whenever requested.

b. The Sponsoring Institution must have the appropriate mechanisms in place to allow all appropriate parties access to the schedule of physicians and House Staff Officers to allow for safe and effective transitions of care. In addition, these schedules should clearly delineate the responsible physician and/or House Staff Officer for a given patient at any time, to ensure that proper care and oversight is provided for each patient.

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c. The Office of GME will monitor the entry of schedules into New Innovations to ensure that House Staff Officer and faculty schedules are entered.

d. The Office of GME will grant view-only access of these schedules to necessary parties, such as nurses who are working alongside House Staff Officers in caring for a patient.

C. Training Program Responsibilities

a. Each program just have its own policy for transitions of care/handoff. These policies must address any specialty-specific tasks necessary for a safe and effective transition of care. These policies should address, but are not limited to:

i. The accepted standard for transitions of care within the department or program

ii. Expectations for following the Transition of Care Policy

iii. Course of Action in the event that a House Staff Officer violates this policy

iv. Instructions on how the program intends to educate all House Staff Officers on how to perform appropriate and safe transitions of care.

v. The required level of supervision for transitions of care for different levels of trainees and/or patient care.

b. All schedules and call-schedules must be made available to nurses, attendings,

and other House Staff Officers through New Innovations or other appropriate methods.

c. The Training program must ensure that the schedules of House Staff Officers minimizes the

number of transitions of patients to maintain patient safety and continuity of care, and also allow

House Staff Officers to comply with ACGME and New York State Duty Hour regulations. V. Related Policies (if applicable) A. Duty Hour Policy for House Staff Officers B. Alertness Management/Fatigue Mitigation

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Book & Conference Fund


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Patient Safety/Quality Improvement Resources, Expectations & Curriculum Patient Safety and Quality Improvement Curriculum A required Patient Safety and Quality Improvement curriculum was designed for all trainees in the

Department of Surgery with a one hour conference every other month, led by an attending facilitator. The

conference includes a presentation and discussion of the literature pertaining to each safety issue listed

below. This is followed by a review of NYU-specific data and comparison to the national data. Attendees

conclude with a review of the hospital’s policy for each safety issue and a discussion of what can be done

at the resident level to improve patient safety and outcome. This curriculum will meet the following goals:

• Competency in Practice Based Learning

• Competency in Systems Based Practice

• Better understand the current health care environment and the roles of the major players (i.e., governmental and non-governmental agencies, hospitals, professional societies and advocacy groups) that shape the practice of medicine

• Be familiar with quality and safety literature

• Learn how to create evidence-based practice guidelines to improve patient safety and outcomes for the hospital as well as our own personal practices

Curriculum includes:

• Overall review of the current health care environment including policy, reimbursement, safety

initiatives and measures

• DVT prophylaxis

• Postoperative UTI

• Postoperative wound infection/wound protective devices

• Ultrasound guided CVL placement

• Postoperative confusion/hospital delirium

In addition to the didactic patient safety curriculum, the Department has a QI meeting every Friday with senior trainees to discuss every complication from the week on each service at Tisch and at Bellevue. The department has also developed a Quality Improvement Committee, that will report to the hospital Quality Improvement Committee that includes department trainees. Trainees also participate in resident-run Mortality and Morbidity conferences and root cause analysis as part of their core curriculum.

Participation is mandatory of all Department of Surgery trainees.

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Education and Scholarly Activities for Trainees

It is expected that each year during the fellowship program, each fellow will:

• demonstrate initiative by selecting an area of interest and, working with a mentor, pursuing a research project within this area

• design a research project or join an ongoing research project

• submit at least one abstract to a national vascular meeting

• submit at least one manuscript to a peer-reviewed journal

• demonstrate competency in all areas of research including grant preparation, experimental design, data collection, data analysis and data publication

If the fellow is interested in doing scholarly activity or research, they should arrange and meeting for discussion with either the Program Director, Caron Rockman or Associated Program Director, Mikel Sadek.

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Education and Scholarly Activities for Faculty

Department of Surgery has a robust mentoring program for junior faculty where each faculty member needs to:

• Publish a minimum of one paper year in a peer-reviewed journal

• Attend at least one national and one regional meeting per year

• Fulfill all teaching assignments for our medical students and residents

as requested by Dr. Berman and Dr. Hochberg, the Vice Chair for

Education and Associate Vice Chair for Education.

• Participate in at least one medical school or hospital committee as our

Department of Surgery representative.

• Apply for at least one grant from a governmental (NIH, DoD, NYCHHC)

or a private funding source each year.

In addition, each Division has clinical research projects that the faculty are involved in. The department also has clinical databases in Bariatric, Breast Surgery, Endocrine Surgery, GI Surgery, and Vascular Surgery to perform Quality improvement based research. The Department is also working on Faculty development sessions to promote presentation skills, teach the residents and medical students and learn to do direct observation for the trainees.

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Clinical Competency Committee Description (CCC)

Clinical Competency Committee of the Vascular Surgery Fellowship Program

The Program Director will appoint a Clinical Competency Committee. (V.A.1.) 1. Committee Membership

a. The Clinical Competency Committee will be composed of 4 members of the Program Faculty (V.A.1.a.)

b. The Clinical Competency Committee will be comprised of vascular surgery integrated core faculty who dedicate 30 or more hours per week to Trainee education.

2. The following is the written description of the responsibilities of the Clinical Competency Committee: (V.A.1.b.)

a. The Clinical Competency Committee must: [V.A.1.b).(1)] i. Meet and review all trainee evaluations every six months. [V.A.1.b).(1).(a)] These

evaluations might include: 1. rotation performance evaluations 2. procedural competence evaluations and procedure logs 3. multisource evaluations 4. transitions of care evaluations 5. research evaluations 6. simulation evaluations 7. unsolicited submissions to the Program Director and other Faculty that

pertain to trainee performance ii. Prepare and assure the reporting of Milestones evaluations of each trainee semi-

annually to ACGME; [V.A.b).(1).(b)] and iii. Advise the Program Director regarding trainee progress, including promotion,

remediation, probation and dismissal. [V.A.b).(1).(c)] The CCC will monitor trainee progress on all remediation plans. The final decision for implementing such remains with the Program Director.

(Blue font denotes adaptation taken from ACGME Common Program Requirements for Graduate Medical Education) Membership of the Vascular Clinical Competency Committee (CCC) for the 2019-20 Academic Year(s) is as follows: Dr. Joanelle Lugo, Dr. Mikel Sadek, Dr. Neal Cayne and Dr. Glen Jacobowitz.

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Program Evaluation Committee Description (PEC)

Charge of the Program Evaluation Committee (PEC) Vascular Surgery Fellowship Training Program

1. The Program Director will appoint a Program Evaluation Committee (PEC). 2. The Program Evaluation Committee will include at least 3 Core Program Faculty members and 2

Trainees. 3. This document will serve as a written description of the PEC’s responsibilities.

a. The Faculty members of the PEC will serve for at least 2 terms. b. The trainee representative(s) will serve for 2 year(s), as determined by the committee

chair. 4. The PEC will participate actively in:

i. planning, developing, implementing, and evaluating educational activities of the Program;

ii. reviewing and making recommendations for revision of competency-based curriculum goals and objectives;

iii. addressing areas of non-compliance with ACGME standards; and, iv. reviewing the Program at least annually using evaluations of Faculty, Trainee and

others, as specified below. 5. The Program, through the PEC, will document formal, systematic evaluation of the curriculum at

least annually, and will be responsible for rendering a written Annual Program Evaluation (APE) based on each academic year. The PEC will meet at least once per year. The Program will monitor and track each of the following areas:

a. Trainee performance as determined by the Clinical Competence Committee b. Faculty development c. Graduate performance, including performance of Program graduates on the certification

examinations in accordance with your program specific requirement d. Program quality;

i. Assessment of resources 1. Case numbers and clinical resources 2. Personnel 3. Funding 4. Space 5. Equipment 6. Information technology

ii. Trainees and Faculty members will have the opportunity to evaluate the Program confidentially and in writing at least annually, and

iii. The Program will use the results of Trainees’ and Faculty members’ assessments of the Program together with other Program evaluation results (ACGME Trainees and Faculty’s surveys, ACC In-Training Examination) to improve the Program.

e. Progress on the previous year’s action plan(s). 6. The PEC will prepare a written plan of action (program improvement plan - PIP) to document

initiatives to improve performance in one or more of the areas listed in section 3 as well as delineate how they will be measured and monitored.

a. The action plan (PIP) will be reviewed and approved by the teaching Faculty

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b. The action plan (PIP) and its approval will be documented in meeting minutes.

Membership of the Vascular Program Evaluation Committee (PEC) for the 2019-20 Academic Year(s) is as follows: Dr. Glenn Jacobowitz, Dr. Michael Barfield, Dr. Thomas Maldonado and Dr. Todd Berland

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Evaluation of the fellow by the faculty

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Evaluation of the faculty by the fellow

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Multiple Evaluators (peers, self, etc)

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Semi-Annual Evaluation (by the Program Director)

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Summative Evaluation (by the Program Director)

SUMMATIVE EVALUATION LETTER Date Dr. Name Address Dear Dr. _________: This is the final Letter of Evaluation for Dr. _______who will complete his fellowship in Vascular Surgery on _____________. Dr. _____ has been very successful in the NYU Environment. In summary, his performance was outstanding and as such he was asked to join the faculty and staff at______________________. Dr. _____is outstanding technically and his case review demonstrates more than adequate experience in both open and endovascular procedures. He has a superb fund of knowledge as demonstrated by excellent scores on the in-service examination as well as evaluations by the faculty. He/She has done an excellent job in teaching and has received very positive feedback from resident and medical students regarding his teaching. He has done an excellent job in conference preparation with published manuscripts and peer-review journals. He has been successful at presenting his research to national meetings. It is my opinion as Director of the Vascular Fellowship that Dr.______ is more than competent in the field of vascular and endovascular surgery and has sufficient experience and knowledge that he can work independently. He should be successful in completing board certification in Vascular Surgery. Thank you. Sincerely yours,

Caron Rockman MD

Florence and Joseph Ritorto Professor of Surgical Research

Program Director in Vascular Surgery

NYU Langone Medical Center

530 1st Avenue, Suite 6F

New York, NY 10016

[email protected]

212-263-7311

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Evaluation of the program by the fellow

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Evaluation of the program by the faculty

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Other Evaluations

Below please find the link to the ACGME Vascular Surgery Milestones. The Clinical Competency Committee, composed of four core Vascular Surgery faculty, will evaluate trainee performance on a semi-annual basis against the milestones. Milestones will be reported to the ACGME and will be discussed with the trainees during the Semi Annual Reviews.

http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/SurgeryMilestones.pdf

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Examinations, Licensure & Certificate Below please find the requirements for all Vascular Surgery Fellows:

a. Prior to being interviewed for fellowship, applicants are required to take and pass USMLE step I; USMLE Step 2 and USMLE 3.

b. Residents who graduated from a foreign medical school, except Canada, are required to be ECFMG certified prior to starting residency.

c. Fellows are required to have obtained their National Provider Identification number prior

to beginning fellowship.

d. Fellows are required to be ACLS/BLS certified throughout their training.

e. Fellows are required to be ATLS certified.

f. All residents are required to take the VSITE (Vascular Surgery In Service Training Examination) on an annual basis. The examination is set by the ABS and typically occurs in March.

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Policy for Resident/Fellow and Faculty Member Well-Being

Division of Vascular Surgery

The NYU Department of Surgery’s Division of Vascular is committed to the wellbeing of our Surgery Housestaff

and Surgery Faculty Members. NYU Langone Health provides free medical/dental benefits to all employees earning less that 80K a year and significantly reduced the cost for those earning more. In addition, the

Department of Surgery sponsors social events for both residents and faculty. The program director and faculty

mentors address and encourage conversation with their resident mentees regarding wellness and it is a topic

of discussion during semi-annual reviews with the program director. NYU Langone Health is pleased to provide the faculty and residents with the following physical and mental health resources: Mental Health Resources for NYU House Staff:

• David Stiffler, MD (covering for Dr. Ackerman while on maternity leave): email:

[email protected]; phone 646-754-4742

• 1 Park Ave House Staff Mental Health Program

• Appts Mon-Thurs 6-9pm, Sat 10am-4pm (biweekly); email/call Dr. Stiffler for appt

• 24 hour helpline: 1-800-833-8707 (Master’s or PhD level counselors answer the phones and

provide immediate telephone assessment and crisis support)

Bellevue Payroll:

• CIR will reimburse $160 per session with a psychiatrist, up to $5000 per calendar year, and

can be combined with your benefit plan

• GHI-CBP: excellent out of network benefits for mental health

• $108 per session with a psychiatrist • $60 per session with PhD psychologist

NYU Payroll:

• NYU United PPO (top tier): largest network for mental health, $10-20 copay

• UHC HMO: no out of network mental health coverage • Empire HMO: no out of network mental health coverage

• Recommend you review costs and coverage of each plan and keep above in mind re:

mental health coverage Mental Health Resources for NYU Faculty:

• NYU United PPO (top tier): largest network for mental health, $10-20 copay

• UHC HMO: no out of network mental health coverage • Empire HMO: no out of network mental health coverage

• Recommend you review costs and coverage of each plan and keep above in mind re:

mental health coverage

2 24 hour helpline: 1-800-833-8707 (Master’s or PhD level counselors answer the phones and

provide immediate telephone assessment and crisis support)

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The program has also initiated a new Wellness Curriculum lecture series on the following topics

beginning in 2019-2020. Wellness Curriculum Lecture Series to take place during core didactics on Thursday Mornings parallel

with basic science curriculum

o Lectures on:

• Cultural diversity, stress of surgical practice, managing your career (Dr. Hochberg)

• Resilience – Bouncing back from a professional or personal crisis (Dr. Hochberg)

• Sleep management presentation (Pulmonary Sleep Specialists)

• Ergonomics in the OR presentation (OT and PT specialists)

• Intro to personal finances- student loans, health insurance, life insurance, retirement

planning (Presenter TBD)

• Mindful and Healthy Eating Lecture (Presenter TBD)

• Quick Exercises for the Busy Resident Presentation (Presenter TBD)

• NYU Housestaff Mental Health Services and CCA Presentations (Dr. Ackerman/Dr.

Stiffler, CCA Representative)

Professionalism (SPICE) Curriculum

• The Department of Surgery has a robust curriculum on professionalism and interpersonal

communications.

• The NYU Department of Surgery inagurated this curriculum in 2007 and have improved and refined

these interactive seminars each year.

• To test these competencies, we instituted annual OSCE (Objective Structured Clinical Examinations)

with specially trained actors for our surgical resident learners.

The interactive group sessions are centered on the following topics:

• Medical Malpractice and the Surgeon • Advanced Communication Skills for Surgical Practice • Residents as Teachers Lecture • Admitting Mistakes: Ethical and Communication Issues • Delivering Bad News: Your Chance to Become a Master Surgeon • Working With Professionals Around You: Team Communication • Working Across Language and Cultures: The Case for Informed Consent • Self-Care and the Stress of Surgical Practice • Resilience – Bouncing back from a professional or personal crisis

There are six standardized OSCE scenarios given prior to the start of training at the R1 year and prior to commencing the R3 year. The cases are:

1. Identifying an impaired surgical resident colleague during a patient care “sign-out” discussion. 2. Communicating to a postop patient that a wrong sided incision was initially made for the hernia repair. 3. Working through a Chinese interpreter to explain to a Chinese woman that she has breast cancer. 4. Explaining to an absentee daughter that her mother, who is an ICU patient, has signed a health proxy

indicating a “do not resuscitate protocol” which is against the daughter’s religious beliefs. 5. Participate in transfer of patient care responsibility effectively, professionally, and accurately of a

patience of a non-surgical patient to a surgical service.

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6. Delivering the bad news of an unexpected operative death to a patient’s spouse in the surgical waiting room

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Mandated Online modules for House Staff

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NYULMC Medical Library Visit the NYU Medical Library on atNYULMC under Popular Links. http://central.nyumc.org/shared/lib/Pages/Home.aspx

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On Call Rooms GENERAL INFORMATION

Apartments 1A and 2G (rooms 2G2 & 2G3) are used for temporary overnight lodging for House Staff and Physical Medicine and Rehab personnel. Apartment 1A is an individual studio apartment. Apartment 2G is a three-bedroom suite. Each room within the 2G apartment is identified with “1”, “2” or “3” on the door.

Room 1A – For House Staff personnel lodging ONLY.

Room 2G-1 -- For Physical Medicine and Rehab personnel lodging ONLY.

Room 2G-2 – For House Staff personnel lodging ONLY.

Room 2G-3 – For House Staff personnel lodging ONLY.

Physical Med & Rehab administrative staff will monitor key issuance, tracking and control for their personnel using 2G1. Security does not have a role or responsibility in this. The keys for rooms 1A, and 2G-2 and 2G-3 will be dispensed by Greenberg Hall Security staff. Keys are tracked and monitored by the Graduate Medical Educational (GME) office.

KEYS

There are three rings located at the Greenberg Security Desk (Post 22). The aluminum plate will state either

“APT 1A”, “APT 2G – 2” or “APT 2G –3”. For “APT 2G – 2” and “APT 2G – 3”, the key ring will have two keys. One

key will be to enter the apartment; the other key is for the room. Gender will not play a role in how the keys are

distributed.

PROCEDURE

There will be a listing of authorized house staff in a binder at the GBH security desk, which is updated monthly. The keys will be issued on a first-come, first- served basis. The intent is for one-night stays under normal circumstances. Security will not monitor length of stays.

DO NOT LEAVE ANY PATIENT INFORMATION OR PERSONAL ITEMS BEHIND WHEN YOU LEAVE THE ROOM FOR THE NIGHT/DAY. The procedure is as follows:

• A House Staff member will request a key to the apartment from the security officer in the

Greenberg Hall Lobby.

• The security officer will inspect the member’s valid ID badge and cross reference it against the House Staff list provided by the GME office. The badge must state “House Staff”. “Visiting House Staff” are not authorized to use these rooms.

• Once validated, a line entry will be completed in the On-Call House Staff

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Lodging Record form; the key will then be issued.

• Weekdays at noon-time (1200 hrs) Monday-Friday, the GBH security officer will place a call to the GME office (212-263-5506) stating the status of the two sets of keys. The office is closed weekends/holidays.

• If a key has not been returned, the GME office will be responsible to contact the House Staff

member(s) to retrieve/obtain outstanding keys.

• If a key is not available when a House Staff member desires a room, the security officer will advise the requestor that the room(s) are taken / not available and have them contact the GME office if there is an urgent need for use of the room.

• If there are any problems during the shift, the security officer will contact a security supervisor at

212.263.5120 (24 hours).

ADDITIONAL ON-CALL ROOMS AVAILABLE -

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Committee Participation for House Staff House Staff are encouraged to participate in various committees (listed below). House Staff Leadership Committee The House Staff Leadership Committee has been newly formed by merging the Combined House Staff Committee and the House Staff Council to serve as a forum for the house staff to consolidate and voice their concerns. Lo uis M il ler , MD is the Fac ul ty A dviso r . The committee also serves a new role as a meeting for house staff to present program activity in each of the CLER focus areas. It is a meaningful forum for house staff to interact with one another and hospital leadership in a structured way, and within the context of NAS/CLER. The members have an important role in providing feedback from programs in terms of progress, and reporting problems and new ideas. A member will also Report to the Medical Board for BH and TH. House Staff members are peer-‐selected residents from each core program who are voted in and appointed by the Chair of the House Staff Leadership Committee. Additional House Staff representatives may attend committee meetings as non-‐voting members; provide information, advice and feedback. The Committee meets quarterly with hospital leadership and members of the GMEEC. New members are elected annually. Please be in touch with your Program Director, Coordinator, or Chiefs if you are interested in participating!

House Staff Patient Safety Council The House Staff Patient Safety Council at the NYU School of Medicine was established in June 2012. Dr. Katherine Hochman, MD is the Council's faculty advisor. The House Staff Patient Safety Council is comprised of house staff who are committed to quality improvement and patient safety throughout the institution. The hospital administration and GME Office are very interested in having residents directly engaged in patient safety and quality improvement activities, and are all fully supportive of our Council. Four executive leaders are elected by fellow house staff at a HSC meeting in the beginning of the year. New members are elected annually. Please be in touch with your Program Director, Coordinator, or Chiefs if you are interested in joining the council! House Staff Wellness Committee The House Staff Wellness Committee has been newly formed. Carol Bernstein, MD (Psychiatry Residency Program Director) is the Council’s faculty advisor. The House Staff Wellness Committee is a subcommittee of the GMEC. It is comprised of House Staff officers. The mission of the House Staff Wellness Committee (HSWC) is to provide a structured, sustainable committee, which will identify and address issues related to the wellness and mental health needs of all House Staff at New York University Langone Medical Center (NYULMC), Bellevue Hospital Center (BHC), and the Veterans Affairs New York Harbor Healthcare System (VA-NY). The Committee meets the second Thursday of every month at 6pm. Location to be determined. New members are elected annually.

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Additional Information

Identification Badges There are at least three IDs that House Staff will need and potentially more, depending on the sites at which you will be working. The three are: NYULMC, Bellevue and the VA (Manhattan). Your program will help you determine if any additional ID badges are needed. NYULMC ID badges NYU Langone Medical Center policy requires all employees to wear an identification badge while on Medical Center property. Identification badges are distributed by the NYULMC Security Office. Location: 550 First Avenue, Room 182 Medical Science Building (MSB) – follow the yellow pathway Phone: 212-263-5038 Bellevue ID badges If you will be working at Bellevue Hospital, you MUST obtain a Bellevue ID badges. To do so, you may go to the Bellevue Hospital Police Office. Location: 462 First Avenue, Room GD-17 Monday-Friday: 7:00am – 5:00pm Closed: Noon-1:00pm Phone: 212-562-2345 Veterans Affairs Medical Center (Manhattan Campus) ID badge Obtaining of this ID badge requires the completion of appropriate security forms which vary depending upon your access requirements. These may include a Special Agency Check (electronic fingerprint scanning) and National Agreement Check & Inquiry.

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MCIT Telecommunications As an NYULMC Resident/Fellow, you will be assigned a personal long-range alpha/text pager capable of being activated via telephone, email or SMS text. Your personal pager will accompany you throughout your training years at NYULMC. If you have questions about your pager please contact the Telecommunications Department. Location: Greenberg Hall, 545 First Avenue Level SC-1, Room 129 Hours: Monday-Friday: 9:00am – 5:00pm Phone: 212-263-1120

Linen Services Long white coats and scrubs are available to all members of the House Staff via machines located on the floors. You can retrieve your scrub code for these machines at the Linen Services Room. You must present your NYULMC ID badge when picking up or exchanging your linens. Location: Kimmel Pavilion, 1st Floor, Room 808 Hours: Monday-Friday: 6:30am – 4:00pm Closed: 10:00am – 11:30am for inventory Saturday: 9:00am – 5:00pm Phone: Extension 73134 or 33012 (inside hospital) or 212-263-3014 (outside hospital) Machine Locations: Tisch Hospital: Floors 2, 5, 8 & 11 HCC: Floors 2 & 14 Kimmel: 3rd floor

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Useful Links & Resources

Department Main Number NYU Benefits 212-404-3787 NYU Payroll 212-404-4200 NYU Employee Health 212-263-5020 NYU Security 212-263-5038 NYU MCIT 212-263-1120 NYU Linens 646-754-6209 NYU Telecommunications 212-263-1120 NYU Malpractice 646-501-3047 Bellevue HR 212-562-6283 Bellevue Payroll 212-562-4406 Bellevue Benefits 212-562-8218 Bellevue Clinical Systems 212-562-4797 Bellevue Security 212-562-2345 CIR (Union) 212-356-8100

ACGME: http://www.acgme.org/acgmeweb/ ACGME Webinars: http://www.acgme.org/acgmeweb/tabid/431/ProgramandInstitutionalAccreditation/NextAccreditationSystem/Webinars.aspx New York Medical License: http://www.op.nysed.gov/prof/med/medlic.htm

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http://www.acgme.org/acgmeweb/

http://www.acgme.org/acgmeweb/tabid/431/ProgramandInstitutionalAccreditation/NextAccreditationSystem/Webinars.aspx

http://www.acgme.org/acgmeweb/tabid/431/ProgramandInstitutionalAccreditation/NextAccreditationSystem/Webinars.aspx

http://www.op.nysed.gov/prof/med/medlic.htm

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